Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury

Assessment of ambulance interventions; proposal of a performance measurement framework for healthcare improvement in EMS response to patient collapse

BACKGROUND

Healthcare improvement at all levels involves systematic and continuous assessment of the system's operations, efficiency, and effectiveness to ensure quality care. Likewise, in Emergency Medical Services; performance measurement and root cause analysis may aid in identifying the system inadequacies and address potential shortcomings by developing Key Performance Indicators. In this paper, we propose a tailored framework to supplement the performance measurement and healthcare improvement, primarily to monitor the quality of EMS operations and personnel for ambulance transfers, which results in patient collapses in ambulances.

METHODS

We developed a Performance Measurement Framework (PMF) based on three essential domains- Structure/System, Process, and Outcome. Each domain was further assigned with different KPIs to assess the performance of EMS operations and personnel during patient transfers. The framework was pilot-tested for one year from January to December 2023, where its use was limited to the cases of patient collapse in ambulances, also referred to as out-of-hospital deaths. To assess progress, we compared the incidence of CIA between the pre-implementation and post-implementation phases, with service operational metrics including coverage, fleet size, workforce, and response times.

RESULT

Using the PMF as a tool for quality improvement, we observed a 7% reduction in the incidence of patient collapse in ambulances and a 16% reduction in life-threatening cases resulting in CIA despite increases in service coverage (37%), ambulance workforce (32%), fleet (26%), and routine interventions (11%). A slight increases in response times indicate the greater service demands. Through pilot testing, we identified operational gaps including behavioral and communication issues, adherence to SOPs, and equipment management.

CONCLUSION

Overall, this paper proposes a performance measurement tool in the field of prehospital care for organizations to thoroughly assess and advance their operations toward healthcare improvement. The study highlights areas requiring improvement such as training guidelines, adherence to operating protocols, and resource optimization. In addition; the integration of technology and advanced training programs for the ambulance workforce may strengthen the overall EMS performance; thereby promising positive patient outcomes, and efficient service delivery and utilization.

TRIAL REGISTRATION

Not applicable.

Time indicators of pre-hospital emergency missions in Qazvin province in 2021-2022

BACKGROUND

Pre-hospital emergency has a crucial role in providing timely care for patients. In this system, seconds and minutes mean the difference between life and death. Considering the importance of the role of pre-hospital emergency in providing services to different patients and the necessity of continuous evaluation of this system, the present study was conducted to investigate time indicators in pre-hospital emergency missions.

METHODS

This cross-sectional study was conducted in 2022 in Qazvin province, Iran. The research population was all the calls made to pre-hospital emergency bases in Qazvin province The required information, including time indicators and demographic characteristics of the patient, was obtained using the electronic registration system (Asayar). Data were Analysis using descriptive statistics and SPSS 20 software.

RESULTS

Out of the 35,943 patients admitted to the hospital, 20,915 were male while the remaining were female. The mean age of the patients was 44.09 ± 21.82 years. Accidents (29.41%) were the most common reason for contacting the pre-hospital emergency. In all transfer missions, the mean delay time (0:02:23 ± 0:03:33), response time (0:15:02 ± 0:09:42), the time on the scene (0:18:33 ± 0:11:10), total run time (0:54:02 ± 0:25:20), transport time (0:20:25 ± 0:16:49), round trip time (1:32:43 ± 1:08: 43).

CONCLUSIONS

The findings of the present study provided valuable information about the variety and number of missions in a pre-hospital emergency. The results showed that some indicators are within the standard range and some indicators are far from other regions of the country and the world. Increasing the number of bases, increasing the number of ambulances, and Implementation of continuous training courses for personnel can improve time indicators and increase the quality of service to different types of patients.

Generating consensus on road safety issues and priorities in Ghana: A modified Delphi approach

BACKGROUND

Implementation of evidence-based approaches to reduce the substantial health, social, and financial burdens of road traffic injuries and deaths in Ghana and other low-and-middle-income countries (LMICs) is vitally important. Consensus from national stakeholders can provide insight into what evidence to generate and which interventions to prioritize for road safety. The main objective of this study was to elicit expert views on the barriers to reaching international and national road safety targets, the gaps in national-level research, implementation, and evaluation, and the future action priorities.

MATERIALS AND METHODS

We used an iterative three-round modified Delphi process to generate consensus among Ghanaian road safety stakeholders. We defined consensus as 70% or more stakeholders selecting a specific response in the survey. We defined partial consensus (termed "majority") as 50% or more stakeholders selecting a particular response.

RESULTS

Twenty-three stakeholders from different sectors participated. Experts generated consensus on barriers to road safety goals, including the poor regulation of commercial and public transport vehicles and limited use of technology to monitor and enforce traffic behaviors and laws. Stakeholders agreed that the impact of increasing motorcycle (2- and 3-wheel) use on road traffic injury burden is poorly understood and that it is a priority to evaluate road-user risk factors such as speed, helmet use, driving skills, and distracted driving. One emerging area was the impact of unattended/disabled vehicles along roadways. There was consensus on the need for additional research, implementation, and evaluation efforts of several interventions, including focused treatment of hazardous spots, driver training, road safety education as part of academic curricula, promotion of community involvement in first aid, development of strategically positioned trauma centers, and towing of disabled vehicles.

CONCLUSION

This modified Delphi process with stakeholders from Ghana generated consensus on road safety research, implementation, and evaluation priorities.

Occupational safety perceptions of prehospital emergency health services employees: A sample of Sivas central district

BACKGROUND

Prehospital emergency health services ambulance workers are in the risky class in terms of occupational health and safety, and they are faced with more risks due to the fact that they are the first responders to the events, especially regarding COVID-19.

OBJECTIVE

The aim of the present study is to determine the occupational risk perceptions of health care workers and their relations with demographic variables.

METHODS

A literature review was performed to develop a questionnaire. This questionnaire was used in a survey with 250 respondents. The collected data was analysed through factor analysis. Cronbach's Alpha was calculated to verify the reliability of the data.

RESULTS

The risk perceptions of the employees (Factor 1 and Factor 3) differ significantly according to gender. Another important point is that 60.3% of the participants stated that they "agree" with the statement that health workers "experience violence" during work.

CONCLUSION

The risk perception of women was found to be higher, and the reason for this is that women are less physically strong than men along with social gender roles and gender discrimination.

Identifying research priorities for road safety in Nepal: a Delphi study

OBJECTIVE

To identify and prioritise the research needed to help Nepali agencies develop an improved road safety system.

DESIGN

Delphi study.

SETTING

Nepal.

PARTICIPANTS

Stakeholders from government institutions, academia, engineering, healthcare and civil society were interviewed to identify knowledge gaps and research questions. Participants then completed two rounds of ranking and a workshop.

RESULTS

A total of 93 participants took part in interviews and two rounds of ranking. Participants were grouped with others sharing expertise relating to each of the five WHO 'pillars' of road safety: (1) road safety management; (2) safer roads; (3) safer vehicles; (4) safer road users and (5) effective postcrash response. Interviews yielded 1019 research suggestions across the five pillars. Two rounds of ranking within expert groups yielded consensus on the important questions for each pillar. A workshop involving all participants then led to the selection of 6 questions considered the most urgent: (1) How can implementing agencies be made more accountable? (2) How should different types of roads, and roads in different geographical locations, be designed to make them safer for all road users? (3) What vehicle fitness factors lead to road traffic crashes? (4) How can the driver licensing system be improved to ensure safer drivers? (5) What factors lead to public vehicle crashes and how can they be addressed? and (6) What factors affect emergency response services getting to the patient and then getting them to the right hospital in the best possible time?

CONCLUSIONS

The application of the Delphi approach is useful to enable participants representing a range of institutions and expertise to contribute to the identification of road safety research priorities. Outcomes from this study provide Nepali researchers with a greater understanding of the necessary focus for future road safety research.