International Perspectives on Regulation of Patient Safety in the Emergency Care Setting

Document Type

Book Chapter

Publication Date



Patient Safety, Medical Legislation, Patient Error, Hospital Regulation, Emergency Departments, Australia, Denmark, New Zealand, United Kingdom, United States


In recent years a number of jurisdictions have enacted legislation creating new structures to address concerns regarding patient safety. Nowhere are these structures more relevant than in the emergency care setting. This chapter examines developments in Australia, Denmark, New Zealand, the United Kingdom, and the United States. These countries were chosen because they have each studied patient error in their hospitals and have identified patient safety as a policy priority area. Regulatory initiatives in the area of patient safety can be conceptualized as falling into the stages of prevention of error, discovery post-error incident, investigation, and response. Each of these stages can be analyzed discretely for ways in which patient safety might be improved. Ultimately, in an ideal system, each of the post-error stages—discovery, investigation, and response—feed back into prevention such that similar errors will not occur. If initiatives are built into the system to learn from error, a continuous loop of detection, mitigation, investigation, and improvement will result. This much we owe to patients who suffer injury due to error. Although this text focuses on the emergency department (ED), regulatory actions are not necessarily particular to the emergency setting. This is because in each case the ED is part of a broader system of regulatory structures. For example, hospitals fall under specific legislation, professionals working in the department are regulated, and medications and medical devices fall under separate regulation. Emergency departments generally fall under the same reporting structures as other parts of the hospital. In addition, the legal system's response to error in the emergency context involves the same actors and governing bodies—e.g., the tort system or a replacement compensation scheme, coroners, and professional disciplinary bodies. However, we do know that the ED is prone to unusually high levels of diagnostic uncertainty, decision density, high cognitive load, intense levels of activity, inexperience of some physicians and nurses, interruptions and distractions, uneven and abbreviated care, narrow time windows, shift work, shift changes, compromised teamwork, and weak feedback (1). Thus, given the regularity and seriousness of error resulting from the particular dynamics of provision of care in the ED, these actors and structures might be invoked more frequently than in other contexts.