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SECUre: a multicentre survey of the safety of emergency care in UK emergency departments
  1. Lynsey Flowerdew,
  2. Michelle Tipping
  1. Emergency Department, Frimley Health NHS Foundation Trust, Camberley, Surrey, UK
  1. Correspondence to Dr Lynsey Flowerdew, Emergency Department, Frimley Health NHS Foundation Trust, Frimley GU16 7UJ, UK; lynsey.flowerdew{at}


Introduction According 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.

Methods An 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.

Results 1060 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.

Conclusions This 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.

  • safety
  • emergency department
  • mental health
  • nursing
  • emergency departments
  • qualitative research

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Kirsty Challen

  • Contributors LF conceived and designed this study. LF and MT carried out the study, analysed data and drafted the manuscript. All authors checked and agreed the final manuscript. LF is responsible for the overall content as guarantor.

  • Funding This project was funded by the Royal College of Emergency Medicine and supported by the NIHR Clinical Research Network.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.