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O'connor P, O'malley R, Lambe K, Byrne D, Lydon S. How safe is prehospital care? A systematic review. Int J Qual Health Care 2021; 33:6384516. [PMID: 34623421 PMCID: PMC8547145 DOI: 10.1093/intqhc/mzab138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background As compared to other domains of healthcare, little is known about patient safety incidents (PSIs) in prehospital care. The aims of our systematic review were to identify how the prevalence and level of harm associated with PSIs in prehospital care are assessed; the frequency of PSIs in prehospital care; and the harm associated with PSIs in prehospital care. Method Searches were conducted of Medline, Web of Science, PsycInfo, CINAHL, Academic Search Complete and the grey literature. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies reporting data on number/frequency of PSIs and/or harm associated with PSIs were included. Two researchers independently extracted data from the studies and carried out a critical appraisal using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results Of the 22 included papers, 16 (73%) used data from record reviews, and 6 (27%) from incident reports. The frequency of PSIs in prehospital care was found to be a median of 5.9 per 100 records/transports/patients. A higher prevalence of PSIs was identified within studies that used record review data (9.9 per 100 records/transports/patients) as compared to incident reports (0.3 per records/transports/patients). Across the studies that reported harm, a median of 15.6% of PSIs were found to result in harm. Studies that utilized record review data reported that a median of 6.5% of the PSIs resulted in harm. For data from incident reporting systems, a median of 54.6% of incidents were associated with harm. The mean QATSDD score was 25.6 (SD = 4.1, range = 16–34). Conclusions This systematic review gives direction as to how to advance methods for identifying PSIs in prehospital care and assessing the extent to which patients are harmed.
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Affiliation(s)
- Paul O'connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
| | - Roisin O'malley
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
| | - Kathryn Lambe
- Health Research Board, 67-72 Lower Mount Street, Dublin D02 H638, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland.,School of Medicine, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
| | - SinÉad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland.,School of Medicine, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
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O’connor P, O’malley R, Oglesby AM, Lambe K, Lydon S. Measurement and monitoring patient safety in prehospital care: a systematic review. Int J Qual Health Care 2021; 33:mzab013. [PMID: 33459774 PMCID: PMC10517741 DOI: 10.1093/intqhc/mzab013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prehospital care is potentially hazardous with the possibility for patients to experience an adverse event. However, as compared to secondary care, little is known about how patient safety is managed in prehospital care settings. OBJECTIVES The objectives of this systematic review were to identify and classify the methods of measuring and monitoring patient safety that have been used in prehospital care using the five dimensions of the Measuring and Monitoring Safety (MMS) framework and use this classification to identify where there are safety 'blind spots' and make recommendations for how these deficits could be addressed. METHODS Searches were conducted in January 2020, with no limit on publication year, using Medline, PsycInfo, CINAHL, Web of Science and Academic Search. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies concerned with measuring and monitoring safety in prehospital care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool (the Quality Assessment Tool for Studies with Diverse Designs). RESULTS A total of 5301 studies were screened, with 52 included in the review. A total of 73% (38/52) of the studies assessed past harm, 25% (13/52) the reliability of safety critical processes, 1.9% (1/52) sensitivity to operations, 38.5% (20/52) anticipation and preparedness and 5.8% (3/52) integration and learning. A total of 67 methods for measuring and monitoring safety were used across the included studies. Of these methods, 38.8% (26/67) were surveys, 29.9% (20/67) were patient records reviews, 14.9% (10/67) were incident reporting systems, 11.9% (8/67) were interviews or focus groups and 4.5% (3/67) were checklists. CONCLUSIONS There is no single method of measuring and monitoring safety in prehospital care. Arguably, most safety monitoring systems have evolved, rather than been designed. This leads to safety blind spots in which information is lacking, as well as to redundancy and duplication of effort. It is suggested that the findings from this systematic review, informed by the MMS framework, can provide a structure for critically thinking about how safety is being measured and monitored in prehospital care. This will support the design of a safety surveillance system that provides a comprehensive understanding of what is being done well, where improvements should be made and whether safety interventions have had the desired effect.
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Affiliation(s)
- Paul O’connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Roisin O’malley
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Anne-Marie Oglesby
- Health Protection and Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1, Ireland
| | - Kathryn Lambe
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
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McKinlay A, Morgan M, Noble A, Ridsdale L. Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study. Seizure 2020; 80:56-62. [PMID: 32540637 PMCID: PMC7443693 DOI: 10.1016/j.seizure.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Emergency Department (ED) visits are costly to the health service and alternative care pathways may address this whilst improving outcomes. We aimed to describe decision-making and preferences of people with epilepsy (PWE) during emergency service use, and views of ED alternatives, including use of an Urgent Treatment Centre and telephone-based support from an epilepsy nurse specialist. METHODS We conducted a community-based interview study in South East England, informed by a qualitative framework approach. 25 adults with epilepsy and 5 of their carers took part. RESULTS Participants' choice to attend ED generally corresponded with guidelines, including continuing seizures and injury. Nevertheless, over half reported unwanted or unnecessary ED attendance, mainly due to lack of access to individual patient history, a carer, or seizures occurring in a public place. Participants used proactive strategies to communicate their care needs to others, including 24 -h alarm devices and care plans. Some suggested preventative strategies including referral after ED. Participants highlighted the importance of ambulance staff in providing fast and efficient care that gives reassurance. CONCLUSION Improving communication and access to preventative, proactive services may facilitate better outcomes within existing care pathways. PWE felt ED alternatives were helpful in some circumstances, but Urgent Treatment Centres or epilepsy nurse specialists were not viewed as an ED replacement.
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Affiliation(s)
- Alison McKinlay
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
| | - Myfanwy Morgan
- King's College London, Institute of Pharmaceutical Science, London, UK.
| | - Adam Noble
- University of Liverpool, Department of Health Services Research, UK.
| | - Leone Ridsdale
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
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O’Cathain A, Knowles E, Bishop-Edwards L, Coster J, Crum A, Jacques R, James C, Lawson R, Marsh M, O’Hara R, Siriwardena AN, Stone T, Turner J, Williams J. Understanding variation in ambulance service non-conveyance rates: a mixed methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06190] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In England in 2015/16, ambulance services responded to nearly 11 million calls. Ambulance Quality Indicators show that half of the patients receiving a response by telephone or face to face were not conveyed to an emergency department. A total of 11% of patients received telephone advice only. A total of 38% of patients were sent an ambulance but were not conveyed to an emergency department. For the 10 large ambulance services in England, rates of calls ending in telephone advice varied between 5% and 17%. Rates of patients who were sent an ambulance but not conveyed to an emergency department varied between 23% and 51%. Overall non-conveyance rates varied between 40% and 68%.
Objective
To explain variation in non-conveyance rates between ambulance services.
Design
A sequential mixed methods study with five work packages.
Setting
Ten of the 11 ambulance services serving > 99% of the population of England.
Methods
(1) A qualitative interview study of managers and paramedics from each ambulance service, as well as ambulance commissioners (totalling 49 interviews undertaken in 2015). (2) An analysis of 1 month of routine data from each ambulance service (November 2014). (3) A qualitative study in three ambulance services with different published rates of calls ending in telephone advice (120 hours of observation and 20 interviews undertaken in 2016). (4) An analysis of routine data from one ambulance service linked to emergency department attendance, hospital admission and mortality data (6 months of 2013). (5) A substudy of non-conveyance for people calling 999 with breathing problems.
Results
Interviewees in the qualitative study identified factors that they perceived to affect non-conveyance rates. Where possible, these perceptions were tested using routine data. Some variation in non-conveyance rates between ambulance services was likely to be due to differences in the way rates were calculated by individual services, particularly in relation to telephone advice. Rates for the number of patients sent an ambulance but not conveyed to an emergency department were associated with patient-level factors: age, sex, deprivation, time of call, reason for call, urgency level and skill level of attending crew. However, variation between ambulance services remained after adjustment for patient-level factors. Variation was explained by ambulance service-level factors after adjustment for patient-level factors: the percentage of calls attended by advanced paramedics [odds ratio 1.05, 95% confidence interval (CI) 1.04 to 1.07], the perception of ambulance service staff and commissioners that advanced paramedics were established and valued within the workforce of an ambulance service (odds ratio 1.84, 95% CI 1.45 to 2.33), and the perception of ambulance service staff and commissioners that senior management was risk averse regarding non-conveyance within an ambulance service (odds ratio 0.78, 95% CI 0.63 to 0.98).
Limitations
Routine data from ambulance services are complex and not consistently collected or analysed by ambulance services, thus limiting the utility of comparative analyses.
Conclusions
Variation in non-conveyance rates between ambulance services in England could be reduced by addressing variation in the types of paramedics attending calls, variation in how advanced paramedics are used and variation in perceptions of the risk associated with non-conveyance within ambulance service management. Linking routine ambulance data with emergency department attendance, hospital admission and mortality data for all ambulance services in the UK would allow comparison of the safety and appropriateness of their different non-conveyance rates.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Knowles
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Joanne Coster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Annabel Crum
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Cathryn James
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
- Association of Ambulance Chief Executives, London, UK
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Medical Humanities Sheffield, University of Sheffield, Sheffield, UK
| | | | - Rachel O’Hara
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Tony Stone
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Julia Williams
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
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