… arm remained unchanged at “average” before and after. … Hansen M, Harrod T, Bahr N, et al. The effects of leadership …

Many patient safety strategies focus on effective teamwork among healthcare professionals. This study used a validated instrument, the Clinical Teamwork Scale (CTS), to measure overall teamwork in 44 teams of emergency medical services (EMS) professionals as they responded to 176 simulations of pediatric emergencies. Results indicated that fewer errors were made by teams with higher (better) CTS scores.

Retrospective chart reviews are important tools for identifying potential adverse events and observing trends. This article describes the validation and streamlining of a chart review tool for pediatric prehospital care. The resulting Pediatric Prehospital Safety Event Detection System (PEDS) took an average of seven minutes to complete and had 87% agreement between expert arbiters.  

Few studies have characterized adverse events in emergency medical services (EMS), and even fewer have focused on children. In a chart review of all critically ill pediatric ambulance transports in Multnomah County, Oregon, researchers found that nearly 70% resulted in a patient safety event, 23% of which were severe. The authors call for improved EMS provider training in neonatal care and pediatric resuscitation.

Adverse events in prehospital care are an increasing area of focus in patient safety. In this retrospective study, researchers examined the medical records of 35 out-of-hospital cardiac arrests among children younger than 18 transported by a single emergency medical services system. They identified a safety issue in 87% of cases and, similar to prior research, they found that medication errors were common.

Prehospital emergencies are time critical, and they occur in uncontrolled and often challenging environments. Although emergency medical services (EMS) providers are known to experience high levels of stress, whether their stress contributes to patient safety problems is unclear. In this qualitative study, investigators analyzed perceptions of stress and safety in pediatric out-of-hospital emergencies. They identified factors that contribute to increased stress and therefore adversely affect patient safety, including provider sympathy for children and identification with children or family, which participants felt could cloud their clinical judgment, and lack of familiarity with pediatric emergencies, as seen in other clinical settings. This study highlights a need for specific pediatric training for EMS providers to enhance safety.

Airway management in the prehospital setting can be challenging. Using expert chart review, this retrospective study demonstrated that safety issues associated with pediatric airway management prior to hospital arrival are common, particularly in cases involving cardiac arrest.

Appropriate airway management is a key component of resuscitation in the prehospital setting. This study surveyed prehospital professionals to understand elements of prehospital pediatric airway management that may contribute to patient safety events. Investigators found that insufficient experience with pediatric airway management and difficulty deciding when an advanced airway should be performed were viewed as highly likely to lead to safety events.

Emergency medical services may transport patients from the scene of an accident, an outpatient clinic, or a hospital. This study found that rates of adverse events and near misses were higher when pediatric patients came from accident scenes or clinics than if patients were transferred from other hospitals.

Safety problems in prehospital care can lead to adverse events. In this survey study, investigators used the Delphi method to achieve consensus among emergency medical service providers about perceived challenges of caring for children. Respondents reported a need for training, support for clinical assessment and decision-making, appropriate medication and equipment, and skills and experience with caring for children. Multiple prior studies have documented the risk of adverse drug events among pediatric patients. This study suggests that the safety vulnerabilities in pediatric prehospital care are similar to those in other settings and may benefit by adapting interventions that have addressed these issues. A past AHRQ WebM&M commentary examined the complex issues around medication dosing for pediatric patients.

This review describes how in situ simulation—simulation training that takes place in the actual clinical environment—can be used to detect latent safety hazards and drive improvements.

This commentary highlights the need to evaluate diagnostic reasoning in emergency medicine to address gaps and motivate research exploring factors that impair assessment.

This article describes the development of a teamwork training program involving high-fidelity simulation of obstetric emergencies. The program has been utilized successfully at multiple rural and community hospitals in Oregon.

This article reviews the history of teamwork training in aviation and in health care and summarizes the evidence behind existing programs. The authors highlight the communication skills taught through teamwork training, the adaptation of crew resource management concepts to health care, and the research that is still needed to fully understand the outcomes associated with such programs.

… reporting initiative specific to obstetric care. … Guise JM; Lowe NK; Connell L. …

In this study, only one-quarter of children with high blood pressure were correctly diagnosed with hypertension. The authors attribute this to two factors: pediatricians' lack of knowledge of the normal blood pressure range for different ages and lack of awareness of patients' previous blood pressure measurements.