INTERDISCIPLINARY COORDINATION AMONG EMERGENCY CARE, NURSING, AND HEALTH CARE SECURITY TEAMS IN ENHANCING THE SAFETY OF PATIENTS AND MEDICAL STAFF WITHIN EMERGENCY DEPARTMENTS

Abstract

Background: Emergency departments (EDs) are dynamic and high-risk healthcare settings, the acuity of patients, overcrowding, and workplace violence (WPV) is a major threat to patient and staff safety. Interdisciplinary coordination, especially between emergency care clinicians, nursing personnel, and health care security teams, has been more crucial with regard to risk reduction, enhanced response effectiveness, and building a strong safety culture. Although the significance has gradually increased, the literature is still diverse and there has not been much synthesis of collaborative practices on safety outcomes across disciplines.

Purpose: This narrative review is a critical assessment of evidence regarding the role of coordinated practice in emergency care, nursing, and security teams on the safety of patients and healthcare staff in EDs. The review examines how effective teamwork works, systems of shared communication and interprofessional training programs and determines the main barriers, facilitators, and gaps in the existing research.

Methods: A thorough literature search was performed in PubMed and Google Scholar to find the relevant studies that were published between January 2020 and October 24. Search terms were a combination of Medical Subject Headings (MeSH) and free-text terms dealing with interdisciplinary coordination, emergency care, nursing teamwork, workplace violence, and health care security. English peer-reviewed studies were considered in case they involved collaborative practices and quantifiable safety outcomes in an ED setting. There were systematic reviews, meta-analyses, qualitative, quantitative, and mixed-method studies. The synthesis of the data was done narratively, based on thematic areas of teamwork, prevention of WPV, communication frameworks, and leadership integration.

Findings: The review found in common evidence that structured interdisciplinary coordination can positively affect the patient and staff safety outcomes. Research indicated that training, including Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), de-escalation interventions, and combined security-clinical communication guidelines positively influenced the teamwork climate, decreased the number of incidents of the use of the WPV and positively affected the perception of safety culture. It was also discovered that nurse-physician collaboration minimized adverse events and communication errors, and the proactive involvement of security teams in the process of safety governance aided prompt mitigation of incidents. Nevertheless, there are still issues related to the lack of role definitions, staffing, and uneven application of policies. The gaps in the research are the lack of assessment of coordination models between security teams, the lack of longitudinal outcomes data, and validated tools to assess interprofessional coordination in EDs.

Conclusions: The interdisciplinary coordination of emergency care, nursing, and health care security teams is one of the keys to safety in EDs. New research has shown evidence that integrated training, standard communication, and shared leadership models reinforce high-acuity safety culture and resilience. In order to attain long-term progress, future studies must focus on multi-center, longitudinal studies involving patient and workforce outcomes and determining how far coordination frameworks are scalable to various emergency settings.