• Lynsey Flowerdew and Michelle Tipping.
• Emergency Department, Frimley Health NHS Foundation Trust, Camberley, Surrey, UK lynsey.flowerdew@nhs.net.
• Emerg Med J. 2021 Oct 1; 38 (10): 769-775.

IntroductionAccording to safety theory, frontline staff are often best informed to identify problems that threaten safety in their workplace. Surveying emergency department (ED) staff is a straightforward method for investigating risks, identifying solutions and evaluating interventions. This study's aim was to validate an ED safety questionnaire specifically for use in the UK and provide an overview of safety culture and risks.MethodsAn ED safety questionnaire developed in the USA was modified then validated using 33 RCEM (Royal College of Emergency Medicine) patient safety leads (calculating content validity index). The resulting 39 multiple-choice questionnaire was used in a multicentre survey. 110 participants were randomly selected from each site. A minimum 40% response rate per site reduced non-response bias. Cronbach's alpha was calculated across five categories as an estimate of reliability. Simple descriptive statistics were used to identify risks or good practice. χ2 test compared individual sites' results with national results to highlight outlier questions (ie, the department's strengths and weaknesses). χ2 was also used to identify significant differences between responses from nurses and doctors.Results1060 participants were recruited across 18 sites. Cronbach's alpha was adequate (0.65 to 0.8). Analysis highlighted risks posed by interruptions, negative effects of targets, deficient mental healthcare (especially compared with critical care) and ED crowding. The study also revealed encouraging safety culture, such as effective doctor-nurse communication, and identified sites that were positive outliers overall or for specific questions. Comparing doctors and nurses' responses suggests additional support is needed for nursing staff.ConclusionsThis study provides the first step towards assessing ED safety culture and describing risks in the UK. Identifying outlier sites provides opportunities to learn from excellence. Repeat application of the survey will enable monitoring of safety interventions on a local and national level.© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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