The waiting room safety net: An evolutionary concept analysis of patient safety in the emergency department waiting room

Background: Emergency departments represent a critical point of access to healthcare in Canada, yet escalating pressures from overcrowding are putting patients at increased risk of preventable harm due to increased waiting times. Emergency department waiting rooms are evolving from passive holding spaces to extensions of the clinical care environment however, these spaces are not optimized to facilitate patient safety (Zamani, 2019), putting vulnerable individuals waiting for care at risk of deterioration and adverse outcomes. Waiting room safety netting emerges as a nascent, fragmented idea in the literature yet lacks the specificity and contextual grounding to be operationalized to quality improvement initiatives and patient safety planning. This study aimed to explicate the concept of an ED Waiting Room Safety Net utilizing Rodger’s evolutionary concept analysis to identify the antecedents, attributes and consequences of this construct to inform a systems-oriented, contextually adaptable model for patient safety in emergency care. Methods: Rodger’s evolutionary concept analysis was chosen as the method focuses on concepts emerging through praxis rather than discrete conceptualization acknowledging that meaning arises through practice. Concept analysis occurs through six phases: identifying the concept and related terms, selecting the context and sample for data collection, gathering relevant data, analyzing for attributes, antecedents, and consequences, identifying an exemplar, and determining implications for future development. Results: 52 studies were identified through PubMed using combinations of surrogate terms, 18 scholarly works between 2017 and 2025, were selected and synthesized to derive the antecedents, attributes and consequences of a waiting room safety net. The Waiting Room Safety Net can be defined as: A proactive, responsive, and structured patient safety construct that involves optimizing human factors, technology, organizational processes, and the physical environment such that they interact to facilitate protective oversight of individuals in the emergency department waiting room and enable the avoidance of preventable harm while making the waiting experience more amenable to patients. The synthesis of 18 studies revealed eight thematic attributes which were consolidated into a conceptual model. Implications and lessons learned: A waiting room safety net emphasizes the balanced integration of human oversight, technological innovation and adaptive, aligned organizational processes. Fundamental processes include structured surveillance, clear communication, accountability and escalation pathways. This model offers a systems-thinking informed scaffold for waiting room patient safety and quality improvement initiatives.