Adverse events in prehospital emergency care: a trigger tool study

BMC Emergency Medicine

Monica Munters¹  Elin Seffel²  Lena Nilsson³  Carl Magnusson⁴  Johan Herlitz⁵  Christer Axelsson⁵  Magnus Andersson Hagiwara⁵  Anneli Strömsöe⁶ 

[1] Department of Ambulance Care, Region of Dalarna;Department of Ambulance Care, Södra Älvsborg Hospital (SÄS);Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University;Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital;Faculty of Caring Science, Work Life and Social Welfare, University of Borås;School of Health, Care and Social Welfare, Mälardalens högskola;

关键词: Emergency medical service;    Adverse events;    Patient safety;    Trigger tool;    Prehospital;   

DOI  :  10.1186/s12873-019-0228-3

来源: DOAJ

【 摘 要 】

Abstract Background Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care. Methods We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria. Results The reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9–5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1–0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew. Conclusions There were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid.

【 授权许可】

Unknown