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Kosydar-Bochenek J, Krupa S, Religa D, et al. Int J Environ Res Public Health. 2022;19:9712.
A positive safety climate can improve patient safety and worker wellbeing. The Safety Attitudes Questionnaire (SAQ) was distributed to physicians, nurses, and paramedics in five European countries to assess and compare safety climate between professional roles, countries, and years of healthcare experience. All three groups showed positive attitudes towards patient safety, stress recognition, and job satisfaction; however, overall scores were low.

Farnborough, UK: Healthcare Safety Investigation Branch; June 2022.

Handoffs between prehospital emergency medical services (EMS) providers and hospital emergency departments (EDs) can be suboptimal, which increases patient harm potential. This interim report examines National Health Service discharge delays. It suggests a systemic approach is needed to address flow and capacity factors that contribute to ineffective and unsafe interfacility discharge and transfer.
Johansson H, Lundgren K, Hagiwara MA. BMC Emerg Med. 2022;22:79.
Emergency medical services (EMS) clinicians must decide whether to transport patients to hospitals for emergency care, what level of emergency care they require, or to treat the patient at home and not transport to hospital. This analysis focused on patient safety incidents in Swedish prehospital care that occurred after 2015, following implementation of a protocol allowing EMS clinicians to triage patients to see-and-treat (non-conveyance) or see-and-convey elsewhere. Qualitative analysis of incident reports revealed three themes: assessment of patients, guidelines, and environment and organization. EMS clinicians deviated from the protocol in 34% of cases, putting patients at risk of inappropriate triage to see-and-treat.
Saleem J, Sarma D, Wright H, et al. J Patient Saf. 2022;18:152-160.
Hospitals employ a variety of strategies to prevent inpatient falls. Based on data from incident reports, this study used process mapping to identify opportunities to improve timely diagnosis of serious injury resulting from inpatient falls. Researchers found that multiple interventions (e.g., education, changes in the transport process) with small individual effects resulted in a substantial cumulative positive impact on delays in the diagnosis of serious harm resulting from a fall.
Wilson C, Howell A-M, Janes G, et al. BMC Health Serv Res. 2022;22:296.
Feedback is an essential component of performance improvement and patient safety. Researchers conducted semi-structured interviews with emergency medical services (EMS) professionals in the United Kingdom about their perspectives on how feedback impacts patient care and safety. Findings highlight strong desire for feedback and concerns that inadequate feedback could inhibit learning from mistakes, limit professional development, and negatively impact patient safety.
Lederman J, Lindström V, Elmqvist C, et al. BMC Emerg Med. 2021;21:154.
Patients who are treated by emergency medical services (EMS) personnel but not transported to the hospital are referred to as non-conveyed patients. In this retrospective cohort study, researchers found that older adult patients in Sweden are at an increased risk of adverse events (such as infection, hospitalization, or death) within 7-days following non-conveyance.
Eiding H, Røise O, Kongsgaard UE. J Patient Saf. 2022;18:e315-e319.
Reporting patient safety incidents is essential to improving patient safety. This study compared the number of self-reported (to the study team) safety incidents during interhospital transport and the number of incidents submitted to the hospital’s reporting system. Nearly half of all patient transports had at least one self-reported incident; however, only 1% of incidents were reported to the hospital’s electronic reporting system.
Paulin J, Kurola J, Koivisto M, et al. BMC Emerg Med. 2021;21:115.
Emergency medical services (EMS) personnel are in the unique position of providing medical care outside of a healthcare facility. This prospective cohort study conducted in Finland explored the outcomes of patients who were treated by EMS personnel without going to the ED. Findings indicate that 80% of patients treated by EMS did not have any re-contact with the healthcare system (e.g., re-contacted EMS, went to the ED, were hospitalized), suggesting that EMS management of these patients is relatively safe.
Siebert JN, Bloudeau L, Combescure C, et al. JAMA Netw Open. 2021;4:e2123007.
Medication errors are common in pediatric patients who require care from emergency medical services. This randomized trial measured the impact of a mobile app in reducing medication errors during simulated pediatric out-of-hospital cardiac arrest scenarios. Advanced paramedics were exposed to a standardized video simulation of an 18-month of child with cardiac arrest and tested on sequential preparations of intravenous emergency drugs of varying degrees of difficulty with or without mobile app support. Compared with conventional drug preparation methods, use of the mobile app significantly decreased the rate of medication errors and time to drug delivery.
Jakonen A, Mänty M, Nordquist H. Jt Comm J Qual Patient Saf. 2021;47:572-580.
Checklists have been implemented in a variety of specialties and settings to improve safe patient care. In this study, researchers developed and pilot-tested safety checklists for emergency response driving (ERD) and patient transport in Finland. Semi-structured interviews with paramedics and ERD drivers indicated that the safety checklists improved perceived safety.
Zimmer M, Czarniecki DM, Sahm S. PLoS One. 2021;16:e0250932.
Inadequate team communication is a marker of poor safety culture and can threaten patient safety. This survey of 714 medical and non-medical emergency medical services (EMS) employees in Germany found nearly three-quarters of respondents had been involved in a patient harm incident and that deficits in team communication were a primary contributor.  
Sedlár M. Int J Occup Saf Ergon. 2022;28:1281-1290.
Stress and fatigue experienced by healthcare workers can threaten patient safety. This survey of 131 emergency medical services (EMS) crew members identified a relationship between work-related factors (e.g., stress, fatigue), unsafe behavior, and safety incident involvement. Reducing stress and fatigue and improving cognitive skills, including situation awareness, can improve compliance with safe behaviors.
O’Connor P, O’malley R, Oglesby A-M, et al. Int J Health Care Qual. 2021;33:mzab013.
Patient safety problems can be challenging to detect. This systematic review identified a variety of methods for measuring and monitoring patient safety in prehospital care settings (e.g., emergency medical services, air medical transport). They include surveys, patient record reviews, incident reporting systems, interviews, and checklists.
Venesoja A, Castrén M, Tella S, et al. BMJ Open. 2020;10:e037488.
Safety problems in prehospital care can lead to adverse events. This qualitative study explored patients’ perceptions of safety in emergency medical services (EMS). While patients generally felt safe during their EMS encounter, lack of communication or professionalism among EMS personnel may hinder their sense of safety.
Imach S, Eppich WJ, Zech A, et al. Simul Healthc. 2020;15.
This case study describes the use of root cause analysis to investigate a critical incident occurring during an emergency medicine simulation scenario, and discusses the importance of these investigations in furthering the training of emergency medicine personnel and instructors.
Schewe J-C, Kappler J, Dovermann K, et al. Scand J Trauma Resusc Emerg Med. 2019;27:36.
In Germany, prehospital emergency response teams include physicians, but little is known about their performance with regard to diagnostic accuracy. In this retrospective observational cohort study, researchers analyzed diagnoses made by a German prehospital emergency medical service in 2004 and in 2014. For each patient meeting inclusion criteria, they compared the prehospital diagnosis with the diagnosis made in the hospital and found that diagnostic accuracy improved by more than 5% in 2014 compared to 2004.
Bohm K, Kurland L. Scand J Trauma Resusc Emerg Med. 2018;26:94.
Medical dispatch is charged with deciding the level of acuity of out-of-hospital emergency situations and deploying appropriate emergency services. This systematic review found very little evidence about the accuracy of medical dispatch at identifying cardiac arrest, stroke, major trauma, or the medical priority of callers. The authors call for standardized measures of dispatch accuracy to guide further research.
Alabdali A, Fisher JD, Trivedy C, et al. Air Med J. 2017;36:116-121.
Interfacility transport of critically ill patients may be performed by physician-led teams or by paramedics without direct physician involvement. This systematic review attempted to determine if transport by paramedics alone was safe for patients, but researchers found only a small number of studies with limited characterization of the types of adverse events encountered in this situation.