A Scoping Review of Teamwork, Patient Safety, and Clinician Well-Being in the Emergency Department

Abstract

Background: Emergency departments (EDs) are high-stakes environments where crowding, boarding, and frequent exposure to violence amplify risks to both patients and staff. Conceptual frameworks suggest interdependence between teamwork, well-being, and patient safety, but the empirical basis for these relationships remains underdeveloped. Our objective was to conduct a scoping review examining the intersections between teamwork, patient safety, and well-being in EDs, with the aim of characterizing existing evidence and identifying gaps to inform future research and practice.

Methods: With a medical librarian, we searched Ovid MEDLINE, PubMed, and CINAHL from inception to 2025 using terms related to emergency services, interprofessional teamwork, burnout, and patient safety. Eligible studies included empirical evaluations of team-based interventions or correlates in ED settings; reviews, protocols, and opinion pieces were excluded. Two reviewers independently screened titles, with disagreements adjudicated through abstract review. Full texts were assessed by a second pair of reviewers. Data were extracted into a standardized template following Arksey and O'Malley's methodological framework.

Results: Of 346 studies screened, 16 met inclusion criteria. No study evaluated all three domains simultaneously. Seven studies assessed teamwork-safety relationships using survey or simulation methods and reported associations between stronger teamwork and fewer missed care events, improved safety culture, or enhanced communication. Seven studies examined the teamwork-well-being dyad, finding consistent associations with lower burnout, improved morale, and reduced turnover intentions. Only two studies addressed well-being-safety, reporting negative correlations between job dissatisfaction, poor teamwork climate, and self-reported errors.

Conclusion: Evidence supports associations between teamwork, well-being, and patient safety in the ED, but research remains fragmented, methodologically limited, and rarely addresses all three domains together. Across all domains, studies were limited by reliance on self-reported perceptions, heterogeneous measurement instruments, and lack of ED-specific, longitudinal, or controlled designs. Future studies should leverage multi-institutional, ED-specific designs with objective safety outcomes to build a robust evidence base.