Purpose: Because the patient's perception of safety in the healthcare system has not been adequately examined, the purpose of this study was to discover an Emergency Department patient's perception of safety so as to add an element currently absent in safe patient care provision.

Background: That there is a real and significant problem in the United States healthcare system of providing safe, efficient care to patients is not in dispute. Many agencies, academic researchers, and experts in their fields have studied preventable healthcare errors and proposed and implemented solutions. Yet a careful review of current solutions reveals that patients are not adequately empowered to take an active role in their care, and this fact puts them at greater risk of experiencing a poor outcome due to preventable error. Specifically, patients have not been asked how they, from their role and view as patient, perceive safety.

Methods: This study was undertaken using a qualitative, ethnographic methodology. Eight female and six male participants (six Hispanics, five whites, and three African Americans) with an age range of 22 to 85 years (mean age of 48.5) completed one focused, ethnographic, in-person interview. Content analysis was used to analyze the data.

Results: One main theme, Competent Caring emerged supported by three domains (Accurate Caring, Protective Caring, and Communicative Caring). Examples of patients' perceptions help define several sub-domains which underlie the three domains.

Implications: Safe care for patients is patient involvement in their care as well as making decisions with their healthcare providers. Healthcare providers can meet these expectations by: (a) communicating care information using language understandable to the patient and allowing adequate time for questions to be answered; (b) updating patients about their care on both a scheduled and as needed basis; and (c) not allowing healthcare staff “insider knowledge” to discount patient concerns. Safe care provision also involves meeting physical comfort needs (such as pillows, blankets, food, water, and medicine for noxious symptom control), meeting psychological comfort needs including empathy, and protecting patient physical safety by removing obstacles in their care area, following hand washing guidelines, and identifying the patient through such practices as arm band checking and name / birth date verification.