scholarly journals Factors That Influence Human Error and Patient Safety in the Pre-hospital Emergency Care Setting: Perspectives of Emergency Care Practitioners in a Middle-income Country

Author(s):  
Mugsien Rowland ◽  
Anthonio Oladele Adefuye

Abstract Background: Delivering pre-hospital emergency care has the potential to be hazardous, and the patient could experience an adverse event. Despite these potential, yet known, threats, little is known about patient safety in the pre-hospital care setting, in contrast to in-hospital care. In South Africa, there are no reports on patient safety and human error issues in the pre-hospital care setting. This study investigated the perspectives of emergency care practitioners (ECPs) in South Africa on the types of errors that occur in the pre-hospital emergency care setting, as well as factors that influence patient safety and precipitate errors during pre-hospital care.Methods: This research was designed as an exploratory study that used a questionnaire administered on 2000 ECPs to obtain their perceptions on factors the influence human error and patient safety in the pre-hospital emergency care environment. Results: Of the 2000 questionnaires distributed, 1,510 were returned, giving a response rate of 76%. Analysis of the respondents’ responses in relation to the types of human errors in the pre-hospital environment yielded five dominant themes, namely errors relating to poor judgement, poor skill/knowledge, fatigue, and communication, and human error. According to the participants, inadequate equipment, environmental factors, personal safety concerns, practitioner’s incompetence, and ineffective teamwork are the top five factors that influence patient safety in the pre-hospital emergency care setting. The majority (65.1%; p < 0.001) of public sector ECPs reported that they had not received training on patient safety, nor do they have a protocol for managing medical error at their workplace (65.7%; p < 0.007). Conclusion: In conclusion, this study investigated paramedics’ views on types of errors that occur in the pre-hospital emergency care setting, and factors that influence patient safety and precipitate errors during pre-hospital care. It was found that public-sector emergency medical service (EMS) in South Africa seldom train their staff on patient safety or have a protocol for managing medical error. The study advocates that, to overcome medical errors, EMS in South Africa should establish a culture of safety that focuses on system improvement and personnel training.

2015 ◽  
Vol 167 (5) ◽  
pp. 1143-1148.e1 ◽  
Author(s):  
Jeanne-Marie Guise ◽  
Garth Meckler ◽  
Kerth O'Brien ◽  
Merlin Curry ◽  
Phil Engle ◽  
...  

2021 ◽  
Vol 18 ◽  
Author(s):  
Andrew William Makkink ◽  
Christopher Owen Alexander Stein ◽  
Stevan Raynier Bruijns

Introduction The handover of a patient in the pre-hospital setting is different to other handover settings and therefore requires a different definition and description to that of other patient handover environments. Identifying those factors that affect the efficacy of handover could provide useful for formulating improvement strategies. Aim This research set out to describe the negative experiences of pre-hospital emergency care personnel handing over in the emergency centre in Johannesburg, South Africa, with a view to identifying potential areas for improvement. This paper reports on responses to an open-ended question that formed part of a purpose-designed, paper-based questionnaire that formed part of a mixed-methods study. Methods Data were collected from pre-hospital emergency care personnel within Johannesburg, South Africa. Responses from 140 participants were captured verbatim into Atlas.ti® for coding, analysis and interpretation using a qualitative descriptive methodology. Two themes were generated from a qualitative descriptive analysis of the data: communication barriers, and process barriers to emergency centre handover. These were confirmed by the categories and codes that made up these themes. Conclusion This study identifies some of the factors perceived by pre-hospital emergency care personnel to negatively affect emergency centre handover. It provides insights into how communication and process within the emergency centre have the potential to negatively impact emergency centre handover efficacy.


2021 ◽  
Vol 18 ◽  
Author(s):  
Mugsien Rowland ◽  
Anthonio Oladele Adefuye ◽  
Craig Vincent-Lambert

IntroductionTraditionally, undergraduate emergency medical care (EMC) training programs have, over the years, typically focussed on developing individuals with proficiency in clinical skills who can perform complex procedures in the act of administering safe and effective emergency care in the pre-hospital setting. A shortcoming of this training relates to the attention given to the soft skills needed to work efficiently in a team-based environment. Crisis resource management (CRM) is a structured, evidence-based approach to training that is designed to enhance teamwork performance in critical circumstances where the absence of coordinated teamwork could lead to undesired outcomes. MethodsA narrative review of GOOGLE SCHOLAR, MEDLINE, PUBMED, CINAHL as well as paramedic-specific journals was conducted. Articles were included if they examined the importance of CRM in pre-hospital emergency care; training undergraduate pre-hospital emergency care students on the principles and practices of CRM; and non-technical skills in pre-hospital emergency care. DiscussionResearchers found limited articles related to CRM and the pre-hospital emergency care setting. Our findings reveal that CRM focusses on addressing non-technical skills necessary for effective teamwork and that those identified to be relevant for effective teamwork in pre-hospital emergency care setting include situation awareness, decision-making, verbal communication, teamwork as well as leadership and followership skills. ConclusionEffective team management is a core element of expert practice in emergency medicine. When practised in conjunction with medical and technical expertise, CRM can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of a pre-hospital emergency care plan.


2016 ◽  
pp. 25-48
Author(s):  
Jasmine Tehrani

Patient safety incidents are becoming more common in medical situations. The challenge of achieving significant improvements in patient safety is one of the key tasks facing healthcare at the start of the 21st century. Clinical pathways and clinical guidelines provide a measure of standardisation to help reduce medical error, but are often manually created and also prone to human error. This chapter explores the error issues regarding clinical pathways. It presents a method for generating clinical pathways from a semiotic perspective that can addresses social and informal/safety factors which conspire to influence the outcome of patient interaction and safety.


2016 ◽  
Vol 21 ◽  
pp. 103-109
Author(s):  
Craig Vincent-Lambert ◽  
Richard-Kyle Jackson

Background: The term “financial medicine” refers to the delivery of health-related services where the generation of financial gain or “profit” takes precedence over the provision of care that is reflective of evidence-based best practice. The practicing of financial medicine includes over-servicing and overbilling, both of which have led to a sharp rise in the cost of health care and medical insurance in South Africa. For this reason, the practicing of financial medicine has been widely condemned both internationally and locally by the Health Professions Council of South Africa (HPCSA) and allied Professional bodies.Objectives: This qualitative pilot study explored and described the experiences of South African Paramedics with regard to the practicing of financial medicine in the local pre-hospital emergency care environment.Method: A sample of South African Paramedics were interviewed either face-to-face or telephonically. The interviews were audio recorded and transcripts produced. Content analysis was conducted to explore, document and describe the participants' experiences with regard to financial medicine practices in the local pre-hospital environment.Results: It emerged that all of the participants had experienced a number of financial medicine practices and associated unethical conduct. Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting.Conclusion: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.


2018 ◽  
Vol 20 (2) ◽  
Author(s):  
Jamila Chellan

The National Health Insurance (NHI) in South Africa aims to provide access to quality health services for all South Africans. The NHI will only accredit and contract eligible health facilities that meet nationally approved quality standards both in the public and private sector. Detailed tools for measuring compliance with the National Core Standards (NCS) and Batho Pele principles have been developed and implemented in the public sector. To date and since its implementation in the public sector, very little is known about the national audit tool and the method used to evaluate quality and patient safety standards in private hospitals in the eThekwini district, South Africa. The aim of the study was therefore to assess nurse managers’ perceptions regarding the clinical relicensing audits performed at selected private hospitals in the eThekwini district. A qualitative, exploratory, descriptive design using an interview guide was used to conduct the study. The group of hospitals (N = 4) studied has approximately 40 clinical managers who were sampled for the study. A total of 24 nurse managers were interviewed, guided by data saturation. The results of the study showed that the selected private hospitals in the eThekwini district have not fully implemented the approach to clinical practice standards and healthcare audits in relation to the three clinical domains of the NCS, namely patient rights, patient safety and clinical care, and clinical support services, and the Batho Pele principles. Recommendations are for the internal and external factors influencing the national audit process to be dealt with based on the results of the study.


Sign in / Sign up

Export Citation Format

Share Document