Keywords
aged; emergency department; hospital emergency service; emergency nursing; nursing surveillance; patient safety; accidental falls; wounds and injuries; risk management; dignity; environmental design
Disciplines
Critical Care Nursing | Emergency Medicine | Geriatric Nursing | Other Nursing | Patient Safety
Abstract
Background
Emergency department (ED) bathrooms preserve privacy and dignity but interrupt direct observation. Risks described across clinical publications and professional guidance include falls, unrecognized deterioration, overdose, hazardous ingestion, infection, inaccessible environments, and unmet elimination needs. This review integrated those risks and translated them into a nursing practice framework.
Methods
For the structured narrative review, PubMed/MEDLINE, CINAHL Plus, and Scopus were searched on July 30, 2026, without date, language, age, or publication-type filters. Backward and forward citation chasing and a targeted search for professional documents supplemented database searching. Publications were categorized by ED relevance and synthesized thematically. Professional guidance was analyzed separately.
Results
Of 659 records, 248 duplicates were removed and 311 records were screened. Of the 53 reports sought, 12 were not retrieved, 41 were assessed in full text, and 40 were included; citation chasing evaluated 15 candidates and added 3, yielding 43 publications/reports. Direct or contextual ED evidence was provided by 32 publications, and 11 were transferable. The synthesis identified 6 domains: falls and deterioration; fundamental care, continence, and dignity; overdose, self-injection, hazardous ingestion, and surveillance; infection and equipment; accessibility and design; and privacy and clinical use. Evidence was heterogeneous and largely descriptive, qualitative, quality-improvement, or case-based.
Conclusion
The ED bathroom should be managed as a clinical space rather than an environmental afterthought. This review proposes the original Assess-Assist-Observe-Respond-Document framework, which connects individualized risk assessment, proactive assistance, proportionate surveillance, rapid response, and reassessment. Local validation is required before implementation.
Recommended Citation
Villani, Carmelo
(2026)
"Bathrooms as a Patient Safety Blind Spot in Emergency Departments: A Narrative Review and Nursing Practice Framework,"
HCA Healthcare Journal of Medicine: Vol. 7:
Iss.
5, Article 8.
DOI: 10.36518/2689-0216.2641
Available at:
https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol7/iss5/8
Supplemental Content
Included in
Critical Care Nursing Commons, Emergency Medicine Commons, Geriatric Nursing Commons, Other Nursing Commons, Patient Safety Commons
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