The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use.
Tracey Stone, Jon Banks, Heather Brant and 4 others
PMID 31944438WHAT IT FOUND
Nurses valued the ED safety checklist for prompting hourly monitoring and handovers, but reported skipping it during busy shifts because it duplicated documentation.
Staff viewed it as administrative cover rather than a clinical safety tool, undermining its use when patients were most vulnerable.
Key findings
01Staff perceived the checklist as a supportive framework to prompt and document clinical observations and care tasks, aiding patient tracking in a time-pressured environment.
02During high workload, staff prioritised the clinical observation chart and viewed the checklist as an expendable, duplicative administrative task, leading to non-use when patient risk was highest.
03Implementation strategies framing the checklist as medico-legal cover or evidence for inspectors undermined its core clinical safety purpose.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Small-scale qualitative study in two UK hospitals limits transferability of findings. No quantitative data on whether the checklist actually improved patient safety or reduced deterioration. Observer effect may have influenced staff behaviour during the 66 hours of observation. Patient experience and outcomes were not measured.
Declared interests
Emma Redfern (author) contributed to the original design of the checklist and is a Consultant in Emergency Medicine. Ann Remmers and Emma Redfern are members of the West of England Academic Health Science Network, which supported the checklist's roll-out. The study was funded by University Hospitals Bristol NHS Foundation Trust.
The easy way to misread this
Do not interpret staff's positive views on the checklist as evidence that it improves patient safety outcomes. This study reports perceptions and usage patterns only; it does not measure clinical results like mortality or deterioration detection.