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Teams under pressure in the emergency department: an interview study
  1. Lynsey Flowerdew1,
  2. Ruth Brown2,
  3. Stephanie Russ1,
  4. Charles Vincent1,
  5. Maria Woloshynowych1
  1. 1Centre for Patient Safety and Service Quality, Imperial College, London, UK
  2. 2St Mary's Emergency Department, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Lynsey A Flowerdew, 5th floor, Wright Fleming Building, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK; l.flowerdew{at}


Objective To identify key stressors for emergency department (ED) staff, investigate positive and negative behaviours associated with working under pressure and consider interventions that may improve how the ED team functions.

Methods This was a qualitative study involving semistructured interviews. Data were collected from staff working in the ED of a London teaching hospital. A purposive sampling method was employed to recruit staff from a variety of grades and included both doctors and nurses.

Results 22 staff members took part in the study. The most frequently mentioned stressors included the ‘4-hour’ target, excess workload, staff shortages and lack of teamwork, both within the ED and with inpatient staff. Leadership and teamwork were found to be mediating factors between objective stress (eg, workload and staffing) and the subjective experience. Participants described the impact of high pressure on communication practices, departmental overview and the management of staff and patients. The study also revealed high levels of misunderstanding between senior and junior staff. Suggested interventions related to leadership and teamwork training, advertising staff breaks, efforts to help staff remain calm under pressure and addressing team motivation.

Conclusions This study highlights the variety of stressors that ED staff are subject to and considers a number of cost-efficient interventions. Medical education needs to expand to include training in leadership and other ‘non-technical’ skills in addition to traditional clinical skills.

  • Emergency medicine
  • stress
  • teamwork
  • non-technical skills
  • training

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  • Funding This research was funded by the National Institute of Health Research (grant number P09936). The Clinical Safety Research Unit is affiliated with the Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust which is funded by the National Institute of Health Research. The research described here was supported by the National Institute of Health Research and sponsored by Imperial College.

  • Competing interests None.

  • Ethics approval This study was provided by Barnet, Enfield and Haringey Research and Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.