Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care

Niclas Packendorff, Carl Magnusson, Kristoffer Wibring, Christer Axelsson, Magnus Andersson Hagiwara
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Abstract

Emergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records. The ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers. From the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions. This study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety. What is already known on this topic: The EMS system is potentially a high-risk environment for harmful incidents, and a reporting system could fail to detect adverse events; thus, new methods are needed. What this study adds: This study adds an ATT to the clinical practice to complement the reporting system for the detection of harmful incidents, no harm incidents, and near misses and thus realize increased patient safety in EMS. How this study might affect research, practice, or policy: The detection of harmful incidents, no harm incidents, and near misses in EMS could serve as a foundation for improving patient safety.
开发一种触发工具,用于识别院前急救中的有害事件、无害事件和险情
紧急医疗服务(EMS)是一种独特的环境,因为在复杂和高风险的环境中,所有年龄段的患者都要接受主诉护理,这可能会对患者的安全构成威胁。传统上,报告系统通常用于提高对不良事件(AEs)的认识;但它可能无法检测到不良事件。评估急救医疗服务中的患者安全需要多种方法。有鉴于此,本研究(1)开发了一个全国性的救护车触发工具(ATT),并提供了一份指南,其中包含触发器的描述、使用示例以及险情(NMs)、无伤害事件(NHIs)和有害事件(HIs)的分类;(2)在随机抽取的救护车记录中使用该工具。救护车触发工具是通过以下步骤逐步开发的:(1)文献综述;(2)与具有急救医疗服务、患者安全和触发工具开发知识的专家小组进行三次结构化小组讨论;(3)由来自不同地区的三个评审小组对随机抽取的 900 份日志进行回顾性记录评审;以及(4)评审员之间的互评可靠性测试。从文献综述中得出了 34 项触发因素。通过三次结构化讨论,删除了与临床无关的触发因素,并合并了其他触发因素,最后剩下 19 个触发因素。在随机抽取的 900 份记录中,最常见的触发因素是偏离治疗指南(30.4%)、急救服务评估后未转送患者(20.8%)和记录不完整(14.4%)。正面触发因素分为险情(40.9%)、无伤害(3.7%)和有害事件(0.2%)。评分者之间的可靠性测试表明,两次评分的一致性都很好。这项研究表明,触发工具和回顾性记录审查可作为一种方法,用于测量急救服务中有害事件、无害事件和险情的发生频率,从而与传统的报告系统相辅相成,实现患者安全的提高。关于此主题的已知信息:急救系统可能是有害事件的高风险环境,而报告系统可能无法发现不良事件;因此,需要新的方法。本研究的补充:本研究为临床实践增添了一种 ATT 方法,以补充检测有害事件、无害事件和险情的报告系统,从而提高急救服务中的患者安全。本研究对研究、实践或政策有何影响?发现急救服务中的有害事件、无害事件和险情可作为提高患者安全的基础。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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