With safety in mind : European Journal of Emergency Medicine

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Guest editorial

With safety in mind

Connolly, Jim

Author Information
European Journal of Emergency Medicine ():10.1097/MEJ.0000000000001048, May 26, 2023. | DOI: 10.1097/MEJ.0000000000001048
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The important paper by Petrino et al. [1] analyzes the results of an Emergency Medicine (EM) Day/European Society for Emergency Medicine (EUSEM) survey and highlights the current situation in emergency departments (EDs) across Europe. It follows last year’s survey on burnout among health professionals, which showed an alarming situation and called for urgent action [2,3]. A follow-up position statement [4] highlighted a consensus view on the important minimum standards needed to improve this situation.

This year’s survey into safety and security shows, disquietingly, how little has really changed. Amongst the headline results the authors found that about 90% of professionals feel that at times the number of patients in their ED exceeded the capacity of the department to provide safe care and that overcrowding was currently a regular, serious problem. Overcrowding is not just an issue of discomfort or loss of dignity but adds to inefficiency and carries a substantial risk of harm and increased mortality [5].

Respondents believed that understaffing was another major contributory factor to the current situation and believed that hospital management did not provide sufficient support to rectify this specific issue.

The findings of a patient survey, which is yet to be published (date to be published) were perhaps even more concerning. More patients expressed the view that more ED staff were ‘angry or rude’ than were ‘kind’. Given that the vast majority of those responding to the professional survey said that they were proud to work in an ED, this would appear more likely to be the effects of exhaustion and frustration than a lack of caring. Patient feedback included comments such as ‘There were a lot of patients and very few doctors. Some nurses were very stressed’ and had ‘Far too few doctors for the volume and complexity of many of the patients’.

Most of the responders to the professional’s survey were doctors. It was however noticeable that nurse respondents felt less safe, particularly in respect of the environment in which they were treating people with mental health problems. This in part likely reflects the fact that nurses work more closely with these patients for longer periods of time and so this finding though understandable is concerning.

Last year’s survey found that burnout disproportionately affected younger EM specialists and trainees more so than those who were older and more experienced. We know that negative experiences during training contribute to burnout and depression later in careers, so it remains of concern to see this finding repeated in another domain this year, especially as in some systems the majority of professionals in ED are junior and therefore in greater need of supervision in order to ensure both their own and their patients’ safety. These are the very people we need to support in order to ensure the stability and continuation of ED services in the longer term, so it is particularly worrying that they remain feeling so exposed. We are at serious risk of losing our most important asset to other countries and less pressured specialties with better terms and conditions.

To reduce the risk of this, last year we called for urgent action to be taken to address the question of burnout in ED professionals which had we believe been worsened by the pandemic [4]. It would however appear that little has changed and, if anything, the situation appears to have worsened.

Of particular concern is the finding that some patients who need to go to the ED are too worried about their safety to do so, believing that overcrowding, long waiting times, and exhausted staff will lead to medical error.

This is a completely unacceptable state of affairs and one which affects the most vulnerable and clinically high-risk patients. It is a tragedy that such a situation has been allowed to develop.

Dedicated professionals need the right environment and support in which to carry out their work and patients need to feel reassured that they will get the best treatment. Currently, we would sadly appear to be far from that position.

Governments and healthcare authorities must seek to remedy this situation as a matter of urgency before the situation worsens further at which point it may become too late to arrest the spiral of decline.


The author would like to thank Mary Rice for editing the manuscript.

Conflicts of interest

There are no conflicts of interest.


1. Petrino R, Tuunainen E, Bruzzone G, Garcia-Castrillo L. Patient safety in emergency departments: a problem for health care systems? An international survey. Eur J Emerg Med 2023; 30:XX–XX.
2. Petrino R, Castrillo LG, Yilmaz B. Burnout in emergency medicine professionals after 2 years of the COVID-19 pandemic: a threat to the healthcare system? Eur J Emerg Med 2022; 29:279–284.
3. Khoury A. Burnout syndrome in emergency medicine: it’s time to take action. Eur J Emerg Med 2022; 29:239–240.
4. Petrino R, Castrillo LG, Yilmaz B, Dodt C, Tuunainen E, Khoury A; the Emergency Medicine Day working group. Policy statement on minimal standards for safe working conditions in Emergency Medicine. Eur J Emerg Med 2022; 29:389–390.
5. Royal College of Emergency Medicine. RCEM acute insight series: crowding and its consequences. 2021. https://rcem.ac.uk/wp-content/uploads/2021/11/RCEM_Why_Emergency_Department_Crowding_Matters.pdf[Accessed 22 May].
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