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Work environment influences adverse events in an emergency department

Kurt Rasmussen1, Anna Helene Meldgaard Pedersen1, Louise Pape1, Kim Lyngby Mikkelsen2, Marlene Dyrløv Madsen3 & Kent Jacob Nielsen1 From: see


The psychosocial work environment has been recognised as a factor that contributes to the occurrence of errors and adverse events at hospitals. There has been a strong focus on stress factors at intensive care units and emergency departments. The purpose of this study was to investigate the occurrence of adverse events and to examine the relationship between work-
related stressors, safety culture and adverse events at an emergency department.

Material and methods

A total of 98 nurses and 26 doctors working in an emergency department at a Danish regional hospital filled out a questionnaire on the occurrence and pattern of adverse events, psychosocial work environment factors, safety climate and learning culture.


The participants had experienced 742 adverse events during the previous month. The most frequent event types were lack of documents, referrals not performed, blood tests not available and lack of documentation. Problems related to reporting and learning and insufficient follow-up and feedback after serious events were the most frequent complaints. A poor patient safety climate and increased cognitive demands were significantly correlated to adverse events.


This study supports previous findings of severe underreporting to the mandatory national reporting system. The issue of reporting bias related to self-reported data should be born in mind. Among work environment issues, the patient safety climate and stress factors related to cognitive demands had the highest impact on the occurrence of adverse events.


The project was funded by Trygfonden (grant no 7-10-0949).

Trial registration

Not relevant.

Correspondence: Kurt Rasmussen. E-mail:

Conflicts of interest: Disclosure forms provided by the authors are available with the full text of this article at

Reference: Dan Med J 2014;61(5):A4812

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