Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit

ABSTRACT Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research.

Download Full-text

Medication Related Adverse Events in the Emergency Medical Services: Analysis of a Patient Safety Register

10.21203/rs.3.rs-888734/v1 ◽

2021 ◽

Author(s):

Ian Howard ◽

Ian Howland ◽

Nicholas Castle ◽

Loua Al Shaikh ◽

Robert Owen

Keyword(s):

Patient Safety ◽

Adverse Events ◽

Emergency Medical Services ◽

Adverse Drug Events ◽

Descriptive Analysis ◽

Hospital Setting ◽

Medical Services ◽

Common Error ◽

Emergency Medical ◽

Wide Range

Abstract BackgroundAdverse drug events encompass a wide range of potential unintended and harmful events, from adverse drug reactions to medication errors, many of which in retrospect, are considered preventable. However, the primary challenge towards reducing their burden lies in consistently identifying and monitoring these occurrences, a challenge faced across the spectrum of healthcare, including the emergency medical services. The aim of this study was to identify and describe medication related adverse events (AEs) in the out-of-hospital setting.MethodsThe medication components of a dedicated patient safety register were analysed and described for the period Jan 2017 – Sept 2020. Univariate descriptive analysis was used to summarize and report on basic case and patient demographics, intervention related AEs, medication related AEs, and AE severity. Multivariable logistic regression was used to assess the odds of AE severity, by AE type.FindingsA total of 3475 patient records were assessed where 161 individual medication AEs were found in 150 (4.32%), 12 of which were categorised as harmful. Failure to provide a required medication was found to be the most common error (1.67%), followed by the administration of medications outside of prescribed practice guidelines (1.18%). There was evidence to suggest a 63% increase in crude odds of any AE severity [OR 1.63 (95% CI: 1.03 – 2.6), p = 0.035] with the medication only AEs when compared to the intervention only AEs. ConclusionPrehospital medication related adverse events remain a significant threat to patient safety in this setting and warrant greater widespread attention and future identification of strategies aimed at their reduction.

Download Full-text

Patients’ perceptions of safety in emergency medical services: an interview study

BMJ Open ◽

10.1136/bmjopen-2020-037488 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037488

Author(s):

Anu Venesoja ◽

Maaret Castrén ◽

Susanna Tella ◽

Veronica Lindström

Keyword(s):

Patient Safety ◽

Emergency Medical Services ◽

Professional Competence ◽

Qualitative Content Analysis ◽

Medical Services ◽

Individual Interviews ◽

Driving Skills ◽

Emergency Medical ◽

Perceptions Of Safety

BackgroundResearch on patient safety in emergency medical services (EMS) has mainly focused on the organisation’s and/or the EMS personnel’s perspective. Little is known about how patients perceive safety in EMS. This study aims to describe the patients’ experiences of their sense of safety in EMS.MethodsA qualitative design with individual interviews of EMS patients (n=21) and an inductive qualitative content analysis were used.ResultsPatients’ experiences of EMS personnel’s ability or inability to show or use their medical, technical and driving skills affected the patients’ sense of safety. When they perceived a lack of professionalism and knowledge among EMS personnel, they felt unsafe. Patients highlighted equality in the encounter, the quality of the information given by EMS personnel and the opportunity to participate in their care as important factors creating a sense of safety during the EMS encounter. Altogether, patients’ perceptions of safety in EMS were connected to their confidence in the EMS personnel.ConclusionsOverall, patients felt safe during their EMS encounter, but the EMS personnel’s professional competence alone is not enough for them to feel safe. Lack of communication or professionalism may compromise their sense of safety. Further work is needed to explore how patients’ perceptions of safety can be used in improving safety in EMS.

Download Full-text

Are emergency medical services offload delay patients at increased risk of adverse outcomes?

CJEM ◽

10.1017/cem.2018.478 ◽

2019 ◽

Vol 21 (4) ◽

pp. 505-512 ◽

Cited By ~ 1

Author(s):

Dana Stewart ◽

Eddy Lang ◽

Dongmei Wang ◽

Grant Innes

Keyword(s):

Emergency Medical Services ◽

Care Delivery ◽

Hospital Length ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Medical Services ◽

Emergency Medical ◽

Increased Risk ◽

High Acuity ◽

Offload Delay

ABSTRACTObjectiveEmergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied.MethodsWe used administrative data to study all high-acuity Canadian Triage Acuity Scale 2–3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016. Patients offloaded to a care space within 15 minutes were considered controls, whereas those delayed ≥ 60 minutes were considered “delayed.” Propensity matching was used to create comparable control and delayed cohorts. The primary outcome was 7-day mortality. Secondary outcomes included hospital LOS and 30-day mortality.ResultsOf 162,002 high-acuity arrivals, 70,711 had offload delays <15 minutes and 41,032 had delays > 60 minutes. Delayed patients were more likely to be female, older, to have lower triage acuity, to live in dependent living situations, and to arrive on weekdays and day or evening hours. Delayed patients less often required admission and, when admitted, were more likely to go to the hospitalist service. Main outcomes were similar for propensity-matched control and delayed cohorts, although delayed patients experienced longer ED LOS and slightly lower 7-day mortality rates.ConclusionIn this setting, high-acuity EMS arrivals exposed to offload delays did not have prolonged hospital LOS or higher mortality than comparable patients who received timely access.

Download Full-text

Pediatric Patient Safety in Emergency Medical Services

Clinical Pediatric Emergency Medicine ◽

10.1016/j.cpem.2014.01.003 ◽

2014 ◽

Vol 15 (1) ◽

pp. 18-27 ◽

Cited By ~ 2

Author(s):

Garth Meckler ◽

Julie Leonard ◽

John Hoyle

Keyword(s):

Patient Safety ◽

Emergency Medical Services ◽

Pediatric Patient ◽

Medical Services ◽

Emergency Medical

Download Full-text

Testing quality indicators and proposing benchmarks for physician-staffed emergency medical services: a prospective Nordic multicentre study

BMJ Open ◽

10.1136/bmjopen-2019-030626 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030626 ◽

Cited By ~ 4

Author(s):

Helge Haugland ◽

Anna Olkinuora ◽

Leif Rognås ◽

David Ohlen ◽

Andreas Krüger

Keyword(s):

Adverse Events ◽

Emergency Medical Services ◽

Quality Indicators ◽

Emergency Services ◽

Quality Measurement ◽

Medical Services ◽

Total Quality ◽

Emergency Medical ◽

Sentinel Events ◽

Quality Measurements

ObjectivesA consensus study from 2017 developed 15 response-specific quality indicators (QIs) for physician-staffed emergency medical services (P-EMS). The aim of this study was to test these QIs for important characteristics in a real clinical setting. These characteristics were feasibility, rankability, variability, actionability and documentation. We further aimed to propose benchmarks for future quality measurements in P-EMS.DesignIn this prospective observational study, physician-staffed helicopter emergency services registered data for the 15 QIs. The feasibility of the QIs was assessed based on the comments of the recording physicians. The other four QI characteristics were assessed by the authors. Benchmarks were proposed based on the quartiles in the dataset.SettingNordic physician-staffed helicopter emergency medical services.Participants16 physician-staffed helicopter emergency services in Finland, Sweden, Denmark and Norway.ResultsThe dataset consists of 5638 requests to the participating P-EMSs. There were 2814 requests resulting in completed responses with patient contact. All QIs were feasible to obtain. The variability of 14 out of 15 QIs was adequate. Rankability was adequate for all QIs. Actionability was assessed as being adequate for 10 QIs. Documentation was adequate for 14 QIs. Benchmarks for all QIs were proposed.ConclusionsAll 15 QIs seem possible to use in everyday quality measurement and improvement. However, it seems reasonable to not analyse the QI ‘Adverse Events’ with a strictly quantitative approach because of a low rate of adverse events. Rather, this QI should be used to identify adverse events so that they can be analysed as sentinel events. The actionability of the QIs ‘Able to respond immediately when alarmed’, ‘Time to arrival of P-EMS’, ‘Time to preferred destination’, ‘Provision of advanced treatment’ and ‘Significant logistical contribution’ was assessed as being poor. Benchmarks for the QIs and a total quality score are proposed for future quality measurements.

Download Full-text