Table 2 Focus group on patient safety

Challenges for patient safety

1. Transport to medical facilities

Risk for delayed treatment

2. Transporting patients to other ward units requires two healthcare workers, which blocks intake of new patients

(1 + 2 + 3 + 4 + 5)

3. Moving one patient from a subsequent ward unit to another block transitions from the emergency ward

4. Treatment for patients with delirium tremens or psychosis

Risk for increased violence

5. Insufficient staffing

(5 + 6 + 7 + 8)

6. Crowded ward unit, several patients at the same time

7. Violence and threats from patients

8. Continuous observation

9. Patients with complex somatic and psychiatric needs

Risk of underestimating needs

10. Lack of information to the patients in the emergency ward increases time for enrolment in the next ward unit

(8 + 9 + 10 + 11)

11. Outgrown the premises

Strategies to manage pressure

1. First-line chief of staff works clinically, leads to increased understanding of front-end workers’ needs

Accessible manager

(1 + 2 + 3 + 5)

2. Asking colleagues “what do you need?” instead of monitoring and controlling

3. Accessible doctors

4. It’s easier to say no for the subsequent ward unit if all their beds are occupied

Prioritising treatment

(4 + 6 + 7 + 10)

5. Low hierarchy—anyone can request assistance for a patient in need

6. Workload is not constant—this helps front-end workers recuperate

Innovative competence

7. When ward is overcrowded, doctors can be called with the specific aim of discharging someone

(8 + 9 + 10)

8. All workers have increased their competence in acute somatic healthcare

9. Somatic assessments are made in the psychiatric ward more frequently

10. Treatments can be given in the hallway and the corridor