Emergency Medical Services Provider Perceptions of the Nature of Adverse Events and Near‐misses in Out‐of‐hospital Care: An Ethnographic View

Abstract

Objectives: The objectives were to examine the perceptions of emergency medical services (EMS) providers regarding near-misses and adverse events in out-of-hospital care.Methods: This study uses qualitative methods (focus groups, interviews, event reporting) to examine the perceptions of EMS providers regarding near-misses and adverse events in out-of-hospital care. Results were reviewed by five researchers; analytic domains were assigned and emerging themes were identified. Descriptive statistics were calculated.Results: Fifteen in-depth interviews (73% advanced life support [ALS], 40% volunteer, and 87% male) resulted in 50 event descriptions. Eleven additional event reports were obtained from the anonymous reporting system. Of the 61 total events, 27 (44%) were near-misses and 34 (56%) were adverse events. Fourteen (23%) involved a child (<19 years). Types of error included 33 clinical judgment (54%), 13 skill performance (21%), 9 medication event (15%), 3 destination choice (5%), and 3 others (5%). For the 21 cases where the provider discussed the event, 10 (48%) were reported to a physician, and 9 (43%) to a supervisor; 4 (19%) were not reported, and none were reported to the patient. Focus groups supported interview and event report data. Emerging themes included a focus on the errors of others and a ''blame-and-shame'' culture.Conclusions: Adverse events and near-misses were common among the EMS providers who participated in this study, but the culture discourages sharing of this information. Participants attributed many events to systems issues and to inadequacies of other provider groups. Further study is necessary to investigate whether these hypothesis-generating themes are generalizable to the EMS community as a whole.ACADEMIC EMERGENCY MEDICINE 2008; 15:633-640 ª

Consensus on paramedic clinical decisions during high-acuity emergency calls: results of a Canadian Delphi study

“…5 In an ethnographic study exploring errors, adverse events, and near misses in EMS, the predominant factor was found to be paramedic decision making. 6 This finding was similar to that of a recent qualitative Canadian study in which EMS experts identified CDM as one of two predominant themes influencing patient safety in EMS. 7 During a typical emergency call, paramedics may be presented with a wide spectrum of clinical complaints, scene complexities, and assessment and management demands.…”

EMS Provider and Patient Safety during Response and Transport: Proceedings of an Ambulance Safety Conference

“…When asked to identify the root causes of adverse events, they reported a lack of standardization between agencies and facilities, adversarial interrelationships between EMS providers and allied agency staff and hospital staff, and communication breakdown. 110 Hobgood et al have extensively studied the self-reporting behavior of prehospital care providers. [111][112][113] In a 2006 convenience sample survey of providers, 55% had not reported an error in the previous year, 35% had reported one or two errors, and 9% had reported more than two errors.…”

Patientensicherheit – wo steht der Rettungsdienst?

“…Schwachstellen und (Beinahe-) Zwischenfälle müssen sanktionsfrei gemeldet werden können und zügig, sowie für alle Mitarbeiter erkennbar, aufgearbeitet werden. Nur so kann erreicht werden, dass eine Organisation aus ihren Fehlern lernt[47]. Dieses kann im Rahmen von "Critical Incident Reporting Systemen" (CIRS) geschehen, die zwar schon seit mehreren Jahren in der Notfallmedizin existieren[48], allerdings noch nicht flächendeckend etabliert sind.…”