How safe is prehospital care? A systematic review

Abstract

Background As compared to other domains of healthcare, little is known about patient safety incidents (PSIs) in prehospital care. The aims of our systematic review were to identify: how the prevalence and level of harm associated with PSIs in prehospital care are assessed; the frequency of PSIs in prehospital care; and the harm associated with PSIs in prehospital care. Method Searches were conducted of Medline, Web of Science, PsycInfo, CINAHL, Academic Search Complete, and the grey literature. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies reporting data on number/frequency of PSIs and/or harm associated with PSIs were included. Two researchers independently extracted data from studies and carried out a critical appraisal using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results Of the 22 included papers, 16 (73%) used data from record reviews, and six (27%) from incident reports. The frequency of PSIs in prehospital care was found to be a median of 5.9 per 100 records/transports/patients. A higher prevalence of PSIs was identified within studies that used record review data (9.9 per 100 records/transports/patients) as compared to incident reports (0.3 per records/transports/patients). Across the studies that reported harm, a median of 15.6% of PSIs were found to result in harm. Studies that utilised record review data reported that a median of 6.5% of the PSIs resulted in harm. For data from incident reporting systems, a median of 54.6% of incidents were associated with harm. The mean QATSDD score was 25.6 (SD=4.1, range=16-34). Conclusions This systematic review gives direction as to how to advance methods for identifying PSIs in prehospital care and assessing the extent to which patients are harmed.

Finnish emergency medical services managers’ and medical directors’ perceptions of collaborating with patients concerning patient safety issues: a qualitative study

“…7 Patients could recognise potential risks to their safety in the EMS, such as environmental factors or EMS professionals' driving skills. 4 Still, participants described that patient feedback is more like customer feedback. EMS managers and medical directors mentioned that patient participation in patient safety feedback depends on patient activity.…”

“…44 We do not know how much those costs are in EMS organisations, but patient safety issues cost EMS organisations. Overall, many patient safety incidents in prehospital care 4 give reasons to use every opportunity to reduce patient safety incidents, which come at a cost.…”

“…Approximately 1 in 10 patients experience a patient safety incident in EMS. 4 The working conditions of EMS differ from other healthcare settings. External factors like weather, distance to the hospital and other environmental factors 5 affect how the EMS personnel can perform patient care; those factors affect patient safety 6 and patients’ experiences of safety.…”

Characteristics of low acuity prehospital emergency patients with 48-h mortality, an observational cohort study

“…Eleven patients had primary diagnoses as dead or cardiac/respiratory arrest even though they were delivered alive at the hospital, which supports the claim that there could be a significant amount of time between admission and the assigned final primary diagnosis. Emergency physicians diagnostic accuracy are described in several publications [ 27 – 31 ]. However, the accuracy is described for very specific symptoms and conditions as stroke, cardiac conditions or trauma, and not comparably to our findings due to our population being all conditions, though selected on base of urgency of response combined with 48 h mortality.…”

Prevalence, severity and preventability of prehospital patient safety incidents

“…These occurrences may be termed 'patient safety incidents' (PSIs), themselves defined as 'unintended or unexpected incidents which could have, or did, lead to harm for one or more patients receiving healthcare' (NHS Improvement, 2019). Acknowledging that compared to primary or secondary care, little is known about the extent of patient harm caused by the provision of prehospital care, the systematic review undertaken by O'Connor et al (2021) seeks to establish the prevalence and harm associated with PSIs in the prehospital setting.…”