Patient Safety in Emergency Medical Services: A Systematic Review of the Literature

Bigham, Blair L.; Buick, Jason E.; Brooks, Steven C.; Morrison, Merideth; Shojania, Kaveh G; Morrison, Laurie J.

doi:10.3109/10903127.2011.621045

Cited by 128 publications

(119 citation statements)

References 91 publications

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“…[1] Research evidence can be used to promote emergency care providers' professional identity and competence, increase patient safety and bring out the role of the paramedic practice as a source of research topics for nursing science. [1,3] The term out-of-hospital emergency care used in this article refers to the care of acutely ill patients in a pre-hospital setting. [4] Emergency care consists of rapidly changing, chal-lenging situations, which create a sense of urgency and induce stress in care providers.…”

Section: Introductionmentioning

confidence: 99%

Non-conveyance of patients: Challenges to decision-making in emergency care

Leikkola¹,

Mikkola²,

Salminen‐Tuomaala

et al. 2016

Clinical Nursing Studies

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Background: It has been suggested that emergency care providers' decision-making competence should be strengthened regarding whether or not to transport the patient. This qualitative study describes challenges related to non-conveyance situations from emergency care providers' perspective. Methods: Data were collected by a questionnaire from emergency care providers of a hospital district in Finland in 2014. Responses to open questions were analyzed using inductive content analysis to examine the difficulty of non-conveyance decisions, reasons for non-conveyance and challenges related to the non-conveyance decision after immediate care. Results: The majority (70%) of care providers did not experienced difficulty in making non-conveyance decisions, although those working in basic emergence care found decision-making slightly more challenging than workers in advanced emergency care. Care providers' reasons for not transporting patients were most commonly connected with their assessment of care needs and the conclusion that no hospital care was required. Other reasons involved treating the patient on site, psychosocial reasons and not seeing the patient as an emergency care client. Difficulty of reaching mutual understanding with patients was considered the greatest challenge. Other challenges included worrying about the patient's coping at home and problems in inter-professional co-operation, related to hurry and the concern that doctors did not always document requests for care instructions. Conclusions: The results suggest that care providers' skills in assessing care needs and making decisions based on assessments are a decisive factor in non-conveyance situations. Reaching a mutual understanding with the patient is the greatest challenge.

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Section: Introductionmentioning

confidence: 99%

Non-conveyance of patients: Challenges to decision-making in emergency care

Leikkola¹,

Mikkola²,

Salminen‐Tuomaala

et al. 2016

Clinical Nursing Studies

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“…The mindset of "just culture" is being fostered-an environment where individuals are encouraged to report mistakes or concerns in order to benefit from system-level interventions that make human error less likely. 36,37 Basic research literacy is being introduced as a foundational skill during initial education, with the goal of promoting a culture of evidence-based practice. The profession of paramedicine must continue to reflect on ways to improve reliability and consistency in the care provided by paramedics.…”

Section: Ems Research: a Unique Fund Of Knowledgementioning

confidence: 99%

Applying Hospital Evidence to Paramedicine: Issues of Indirectness, Validity and Knowledge Translation

Bigham

Welsford

2015

CJEM

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The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogmabringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety. RÉSUMÉLa pratique de la médecine d'urgence (MU) est étroitement liée aux services médicaux d'urgence (SMU) depuis plus d'une quarantaine d'années. Aussi les auteurs traitent-ils, dans le présent article, du transfert des données probantes, du milieu hospitalier au milieu préhospitalier. Sera remis en question un dogme admis tant par la MU que par les SMU; en effet, le transfert, sur le terrain, des pratiques en milieu hospitalier n'est pas toujours la meilleure solution. Il sera question, à l'aide d'exemples de traitements préconisés dans les hôpitaux qui se sont soldés par des échecs sur le terrain, du caractère propre du milieu préhospitalier et des raisons pour lesquelles l'application directe des données probantes, recueillies en milieu hospitalier ne convient pas nécessairement au milieu préhospitalier. Les secours paramédicaux sont une discipline en évolution, si bien que la capacité de recherche sur la pratique est suffisamment importante pour jeter une lumière nouvelle sur les pratiques exemplaires. Avant d'envisager l'application des connaissances recueillies en milieu hospitalier, il faut que les données probantes à l'appui soient évaluées par des experts dans trois domaines: l'évaluation critique, la MU et les SMU. Les données probantes de scientifiques devrait faire l'objet d'examen à l'égard: de la qualité et des biais; de l'application directe des données dans la population visée par les SMU ainsi que de leur généralisabilité et de leur validité; de l'ampleur de l'effet et des avantages prévisibles de l'application préhospitalière de ces pratiques; de la faisabilité (y compris l'évaluation économique et la suffisance des ressources humaines dans un environnement mobile); et finalement de la sécurité tant des patients que des fournisseurs de soins.

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“…13 Similar results are confirmed by a systematic review conducted on this topic. 6 With regard to the dispatching phase, most of the problems seem to be related to inefficient communication with the caller (not able to see/interact/evaluate the person in need of help or reporting unrealistic data). Almost 4% of errors were due to a mistaken evaluation of the data (provided during the emergency call).…”

Section: Main Findingsmentioning

confidence: 99%

“…3,4,5 Strong evidence on this topic is still lacking, as shown by a recent systematic literature review on patient safety in emergency medical services (EMS). 6 As suggested by the authors, a key priority is to develop a high-quality self-reporting system that can shed light on adverse events (AE) occurring in EMDC coordination, and guide future interventional research.…”

Section: Introductionmentioning

confidence: 99%

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system

Mortaro

Pascu²,

Zerman³

et al. 2015

CJEM

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Introduction: The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. Methods: An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. Results: During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Conclusions: Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.

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Patient Safety in Emergency Medical Services: A Systematic Review of the Literature

Abstract: We found a paucity of scientific literature exploring patient safety in EMS. Research is needed to improve our understanding of problem magnitude and threats to patient safety and to guide interventions.

Cited by 128 publications

References 91 publications

Non-conveyance of patients: Challenges to decision-making in emergency care

Non-conveyance of patients: Challenges to decision-making in emergency care

Applying Hospital Evidence to Paramedicine: Issues of Indirectness, Validity and Knowledge Translation

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system

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