Walker D, Moloney C, SueSee B, et al. Prehosp Emerg Care. 2022;Epub Jun 27.
Safe medication management practices are critical to providing safe care in all healthcare settings. While there are studies reporting a variety of prehospital adverse events (e.g., respiratory and airway events, communication, etc.), there have been few studies of medication errors that occur in prehospital settings. This mixed methods systematic review of 56 studies and case reports identifies seven major themes such as organizational factors, equipment/medications, environmental factors, procedure-related factors, communication, patient-related factors, and cognitive factors as contributing to safe medication management.
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.
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.
Murata M, Nakagawa N, Kawasaki T, et al. Am J Emerg Med. 2022;52:13-19.
Transporting critically ill patients within a hospital (e.g., to radiology for diagnostic procedures) is necessary but also poses safety threats. The authors conducted a systematic review and meta-analysis of all types of adverse events, critical or life-threatening adverse events, and death occurring during intra-hospital transport. Results indicate that adverse events can occur in intra-hospital transport, and that frequency of critical adverse events and death are low.
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.
O’Connor P, O’Malley R, Lambe KA, et al. Int J Qual Health Care. 2021;33:mzab138.
Patient safety incidents occurring in prehospital care settings are gaining increasing attention. This systematic review including both peer-reviewed studies and grey literature found that the incidence rate of prehospital patient safety incidents is similar to hospital rates. The authors identified an average of 5.9 patient safety incidents per 100 records/transports/patients occurring in prehospital care; approximately 15% of these incidents resulted in patient harm. The authors discuss methodological challenges to preshopital care research and make recommendations for future studies.
Ali A, Miller MR, Cameron S, et al. Pediatr Emerg Care. 2022;38:207-212.
Interhospital transfer of critical care patients presents patient safety risks. This retrospective study compared adverse event rates between pediatric patient transport both with, and without, parent or family presence. Adverse event rates were not significantly impacted by parental presence.
Prior research found significant confusion among physicians in understanding Physician Orders for Life-Sustaining Treatment (POLST) documents, which can lead to errors. This study found that emergency medical services (EMS) personnel did not exhibit adequate understanding of all POLST or living will documents either. The researchers propose that patient video messaging can increase clarity about treatment, and preserve patient safety and autonomy.
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.
Fuller G, Pandor A, Essat M, et al. J Trauma Acute Care Surg. 2021;90:403-412.
Prehospital triage tools are used to differentiate between patients who need emergency care at a major trauma center (MTC) and those that may receive adequate care at a non-MTC. Accurate triage tools are necessary to ensure that patients are not over- or undertriaged. This review found high variability in sensitivity and specificity across geriatric triage tools indicating some patients may not be receiving the specialized trauma care they need. The authors highlight several future research targets including development of relevant reference standards and balancing the risk between over- and undertriage.
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.
Koivulahti O, Tommila M, Haavisto E. Scand J Trauma Resusc Emerg Med. 2020;28:70.
This cross-sectional study evaluated the accuracy of preliminary diagnoses made by paramedics for patients during transport. Agreement between the preliminary diagnosis and the hospital diagnosis was 70% and varied depending on the medical condition.
Mueller SK, Shannon E, Dalal A, et al. J Patient Saf. 2021;17:e752-e757.
This single-site survey of resident and attending physicians across multiple specialties uncovered multiple safety vulnerabilities in the process of interhospital transfer. Investigators found that physicians and patients were both dissatisfied with timing of transfers and that critical patient records were missing upon transfer. These issues raise safety concerns for highly variable interhospital transfer practices.
Dr. Brice is Professor and Chair of the Department of Emergency Medicine at the University of North Carolina. She also serves as the Program Director for the Emergency Medical Services (EMS) Fellowship and was past-president of the National Association of EMS Physicians. We spoke with her about her experience working in emergency medical systems and safety concerns particular to this field.
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.
Center for Leadership, Innovation and Research; CLIR.
Emergency medical services harbor unique challenges to safe patient care delivery. This center serves as a patient safety organization for prehospital care providers, provides access to anonymous reporting tool, and hosts educational opportunities that support a culture of safety in the emergency medical services environment.
Meckler G, Hansen M, Lambert W, et al. Prehosp Emerg Care. 2018;22:290-299.
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.
Hansen M, Eriksson C, Skarica B, et al. Am J Emerg Med. 2018;36:380-383.
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.
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