Question

On a particularly busy night in the emergency department, a patient comes in with chest pain. The triage nurse, who's been on the job only two days, takes the patient's information, fills out the form, and puts the patient's chart on the rack so he'll be seen in the order in which he arrived. She mentions to a passing nurse, "There's a patient here who has pain — he's waiting to be seen." Thirty minutes later, still waiting to be seen, the patient collapses in the waiting room.

During a debriefing, it becomes clear that a nursing assistant was concerned about a patient's breathing just after a drug was administered, but he did not feel comfortable telling the physician. What conclusion can you draw about the unit where this adverse event occurred?

(A) The unit's culture doesn't effectively promote psychological safety.
(B) There are too many patients in the ICU.
(C) The unit's lack of an electronic health record endangers patients.
(D) None of the above

Answer 1

The adverse event indicates a lack of psychological safety in the unit's culture since medical staff felt uncomfortable voicing concerns, leading to a delayed response to a critical patient situation.

Step-by-step explanation:

In the scenario presented, where a patient was not promptly attended to and a nursing assistant hesitated to report concerns to a physician, it reveals a significant problem with the unit's culture. The most accurate conclusion that can be drawn is (A) The unit's culture doesn't effectively promote psychological safety. This conclusion is supported by the fact that staff members felt uncomfortable speaking up about patient concerns and a triage nurse with limited experience did not recognize the urgency of chest pain, which could potentially be a life-threatening condition. Dr. Gawande and Peter Pronovost's studies have highlighted the importance of checklists and protocols, as well as the need for clear communication and psychological safety in medical settings to prevent adverse events and improve patient care. Promoting a culture where all medical staff feel empowered to voice concerns is critical for patient safety.