Frequency and Factors Associated with Patient Safety Events During Prehospital Obstetric Emergencies.

Abstract

Objectives: Patient safety events (PSE) in the prehospital setting are common for high acuity and pediatric patients; however, little is known about PSE during prehospital obstetric emergencies. Our objective was to examine the frequency and factors associated with PSEs during out-of-hospital delivery and postpartum hemorrhage (PPH) treated by emergency medical services (EMS) clinicians in the United States.

Methods: We conducted a cross-sectional evaluation of advanced life support EMS 9-1-1 activations for patients aged 12-50 years with out-of-hospital delivery or PPH in the 2018-2019 National EMS Information System dataset. Patient safety events were defined as adverse events or complications from an EMS-provided intervention, suboptimal actions (e.g., intervention indicated and not given), or errors (e.g., wrong drug dose). Indicated interventions were determined based on the National EMS Model Clinical Guidelines. We fit modified Poisson mixed effects regression models with a random intercept for EMS agency to calculate prevalence ratios, and we calculated marginal adjusted prevalence to identify subgroups at highest and lowest risk of PSEs.

Results: A total of 7,283 activations for out-of-hospital delivery and 1,273 for PPH were included, with 1,960 (27%) activations for out-of-hospital delivery and 882 (69%) for PPH having at least one PSE. For out-of-hospital delivery, multiples, preterm labor, shorter scene times, and higher community diversity were associated with lower prevalence of PSEs, while presence of an obstetric-capable hospital in the county and delivery complication were associated with higher prevalence of PSEs. For PPH, being found at home during the day was associated with lower prevalence of PSEs while delivery complications, multiples, longer scene time, higher community vulnerability, and presence of an obstetric-capable hospital in the county were associated with higher prevalence of PSE. Older age, being at home, complications, longer scene time, and rural location had the highest marginal adjusted prevalence of PSEs during out-of-hospital delivery.

Conclusions: There was a high rate of PSEs during out-of-hospital delivery and PPH treated by EMS, with specific subgroups at highest and lowest risk of PSEs. Focusing on these associations may help guide educational or system resource interventions to help reduce the risk of PSEs.