The association between EMS workplace safety culture and safety outcomes

Perceptions of Patient Safety Culture among Triage Nurses in the Emergency Department: A Cross-Sectional Study

The patient safety culture is key to ensuring patient safety in healthcare organizations. The triage environment is inherently demanding for patient safety and is characterized by high stress, rapid decision-making, and quick action. In several countries, including Slovenia, there is a lack of studies on the patient safety culture among triage nurses. This study aimed to assess the perceptions of the patient safety culture among triage nurses. A cross-sectional survey design was used. The Emergency Medical Services-Safety Attitudes Questionnaire, distributed to triage nurses, was used to collect data. A total of 201 triage nurses participated in this study. The results revealed that the overall average perception of the patient safety culture was 57.27% (SD = 57.27), indicating that the perception of the patient safety culture among triage nurses in the emergency department was non-positive and requires improvement. "Job Satisfaction" received the highest score (63.18%; SD = 17.19), while "Working Conditions" received the lowest (49.91%; SD = 17.37). The perception of positive and negative safety culture responses was statistically significant for age (χ2 (3) = 17.750, p ≤ 0.001), education (χ2 (2) = 6.957, p = 0.031) and length of working experience (χ2 (3) = 8.875, p = 0.031). The findings emphasize the significance of improving the safety culture in relation to several areas of patient care during the triage process. This research serves as a crucial foundation for enhancing patient safety in triage, providing quality care, and reducing adverse events.

Patient Safety Culture: Effects on Errors, Incident Reporting, and Patient Safety Grade

OBJECTIVES

This study mainly examines the effects of patient safety culture dimensions on 4 outcomes (self-reported errors, witnessing errors, incident reporting, and patient safety grade).

METHODS

The data were collected using the Turkish version of the Safety Attitudes Questionnaire, which consists of 6 dimensions (teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions). Of 1679 personnel working in 6 hospitals in Ankara, 860 were randomly selected. The data were analyzed using descriptive statistics, the Spearman correlation coefficient, and binary logistic regression analyses.

RESULTS

The response rate was 62.7%. When the overall patient safety culture score increased by 1 point; the probability of witnessing an error was 2 times lower (P < 0.001), the probability of incident reporting was 4.22 times higher (P < 0.001), and the probability of assessing the patient safety grade as excellent was 29.86 times higher (P < 0.001). The teamwork climate was negatively related to making errors and witnessing errors (P < 0.001). The safety climate and working conditions were positively related to incident reporting and patient safety grade (P < 0.001). Job satisfaction was negatively related to incident reporting (P < 0.001). Perceptions of management were positively related to making errors and patient safety grade (P < 0.001).

CONCLUSIONS

The patient safety culture scores were positively correlated with incident reporting and patient safety grade but negatively correlated with the occurrence of errors. Each dimension of the patient safety culture, except stress recognition, affected different outcomes. Therefore, managers should focus on different dimensions of patient safety culture to improve different outcomes.

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.

Assessing the Mediating Role of Safety Communication Between Safety Culture and Employees Safety Performance

The main purpose of this research was to investigate the mediating role of safety communication (SCO) in the relationship between safety culture (SC) and safety performance (SP) amongst employees in the petrochemical industry. Safety communication methods not only enhance working conditions but also have a positive impact on employee's behaviors and attitudes toward safety leading toward reduced incidents in the workplace environment. A stratified sampling method was followed to collect data in the petrochemical industry in Malaysia. Structural equation modeling (SEM) was utilized to analyze the hypothesized model, using data from 320 participants. The findings reveal that safety communication partially mediates the association between safety culture and safety performance. Further, safety culture was found to have a significant and positive effect on safety performance. This -study makes a significant theoretical contribution by providing empirical evidence on the direct and indirect relationship between safety culture and safety performance in the petrochemical industry.

Exploring safety culture in the Finnish ambulance service with Emergency Medical Services Safety Attitudes Questionnaire

Background

Emergency Medical Services (EMS) is, by its nature, a challenging context that may create risks for both patients and employees. It is also known that an organisation’s safety culture has an influence on both patient and employee safety. Finnish EMS organisations lack knowledge of how their safety culture is perceived by their employees.

Aim

This study aims to test the psychometric properties of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ) in a Finnish EMS setting. We also explore the connections between individual- and organisation-based characteristics and safety attitudes in the Finnish EMS.

Methods

A cross-sectional survey study design was used. The EMS-SAQ was used to collect data via social media. The instrument measures six domains of workplace safety culture: safety climate, teamwork climate, perceptions of management, job satisfaction, working conditions and stress recognition. The 5-point Likert scale was converted to a 100-point scale and mean ≥ 75 was dichotomized as a positive. Confirmatory factor analysis (CFA) was carried out to validate the EMS-SAQ in a Finnish setting. Other results were analysed by using non-parametric tests.

Results

327 responses were included in the analysis. CFA showed that the total EMS-SAQ model had acceptable goodness-of-fit values in the Finnish EMS setting. Total mean scores for each safety culture domain were identified non-positively (mean score < 75); safety climate 60.12, teamwork climate 60.92, perceptions of management 56.31, stress recognition 64.55, working conditions 53.43 and job satisfaction 70.36. Higher education was connected to lower job satisfaction and the teamwork climate within the individual characteristics. All organisation-based characteristics caused at least one significant variation in the safety culture domain scores. Working area significantly affected (p < 0.05) five out of the six safety culture domain scores.

Conclusions

The EMS-SAQ is a valid tool to evaluate safety culture among the Finnish EMS organisations; it offers a novel method to evaluate safety and patient safety within the Finnish EMS organisations. According to the findings, the organisation-based characteristics more likely had an impact on safety attitudes than did the individual-based characteristics. Therefore, it is suggested that the Finnish EMS organisations undertake safety culture development at the organisational level.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-021-00960-9.

Questionnaire for assessing patient safety culture in emergency services: an integrative review

OBJECTIVE

to identify the instruments used to assess patient safety culture in emergency settings.

METHOD

an integrative literature review conducted from 2000 to 2018.

RESULTS

13 instruments were identified to assess patient safety culture in hospital and pre-hospital emergencies, comprising 12 to 50 questions, grouped from three to 12 dimensions, with dimensions related to teamwork, support, and management actions for patient safety and for continuous process improvement and continuing education. The Emergency Medical Service Safety Attitude Questionnaire, which is exclusive for pre-hospital care, stands out.

CONCLUSIONS

the choice and the best decision regarding the instrument are linked to the objectives, the environment and the population to be investigated, as well as the instrument's reliability.

Work-related factors, cognitive skills, unsafe behavior and safety incident involvement among emergency medical services crew members: relationships and indirect effects

Objectives. This study examines relationships between work-related factors - stress and fatigue, cognitive skills - situation awareness and cognitive flexibility, unsafe behavior and safety incident involvement among emergency medical services (EMS) crew members, and whether cognitive skills and unsafe behavior together indirectly affect the relationship between work-related factors and safety incident involvement. Methods. A sample of 131 EMS crew members working in ground ambulances (physicians, paramedics, ambulance drivers) completed self-report questionnaires. Results. The correlation analysis showed significant positive interrelationships between work-related factors, unsafe behavior and safety incident involvement, and that cognitive skills were significantly negatively related to these variables. The multiple indirect effects analysis revealed significant indirect effects of both work-related factors on safety incident involvement through situation awareness and unsafe behavior, but not through cognitive flexibility. Conclusion. In terms of reducing the number of EMS provider and patient safety incidents, the findings suggest the importance of reducing stress and fatigue in EMS crew members, improving their cognitive skills, in particular situation awareness, and supporting their safety compliance behavior.

Measurement and monitoring patient safety in prehospital care: a systematic review

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.

[Association between Safety Culture and Risk of Burnout: A Survey of Non-Medical Rescue Workers]

BACKGROUND

Stressors such as safety culture in organizations that increase the risk of burnout have been studied in nursing and inpatient care settings. However, investigations in the setting of preclinical emergency medical services (EMS) are still limited. The study aims at (1) investigating burnout in health care workers in preclinical EMS and their perceived safety culture, and (2) analyzing the association between the two.

METHODS

Using the Maslach Burnout Inventory (MBI) and the Emergency Medical Services - Safety Attitudes Questionnaire (EMS-SAQ), an online survey was conducted with non-medical health care workers in preclinical EMS. Descriptive analyses were performed using frequencies, mean values, percentages and the Pearson correlation coefficient. A logistic regression model was used to determine the relationship between safety culture and the risk of burnout.

RESULTS

A total of 1,101 questionnaires was considered for analysis. Most of the participants were male (86.2%) and younger than 40 years (73.2%). A high risk of burnout for participants was found for the dimensions of emotional exhaustion and depersonalization (EE 26.3% and DP 40.2%). In the context of measuring safety culture, especially management, working conditions, and safety climate were negatively perceived by the participants. Furthermore, high stress recognition (EE: OR=3.317, p<0.01; DP: OR=1.910, p<0.01), negative job satisfaction (EE: OR=0.297, p<0.01; DP: OR=0.576, p<0.01) and negatively perceived working conditions (EE: OR 0.598, p<0.05; DP: 0.937, p<0.05) were significantly associated with a high risk of burnout.

CONCLUSION

This is the first large scale study investigating burnout among non-medical health care workers in preclinical EMS and their perceived safety culture in Germany as well as the association between the two. The results show the necessity to focus on perceived dimensions of safety culture in organizations, to develop measures reducing stress and improve job satisfaction and working conditions. In the context of increasing skills shortage, this is especially relevant with regard to the challenges of patient safety and quality of outcomes in care.

Patients' perceptions of safety in emergency medical services: an interview study

BACKGROUND

Research on patient safety in emergency medical services (EMS) has mainly focused on the organisation's and/or the EMS personnel's perspective. Little is known about how patients perceive safety in EMS. This study aims to describe the patients' experiences of their sense of safety in EMS.

METHODS

A qualitative design with individual interviews of EMS patients (n=21) and an inductive qualitative content analysis were used.

RESULTS

Patients' experiences of EMS personnel's ability or inability to show or use their medical, technical and driving skills affected the patients' sense of safety. When they perceived a lack of professionalism and knowledge among EMS personnel, they felt unsafe. Patients highlighted equality in the encounter, the quality of the information given by EMS personnel and the opportunity to participate in their care as important factors creating a sense of safety during the EMS encounter. Altogether, patients' perceptions of safety in EMS were connected to their confidence in the EMS personnel.

CONCLUSIONS

Overall, patients felt safe during their EMS encounter, but the EMS personnel's professional competence alone is not enough for them to feel safe. Lack of communication or professionalism may compromise their sense of safety. Further work is needed to explore how patients' perceptions of safety can be used in improving safety in EMS.

Determinants of Occupational Safety Culture in Hospitals and other Workplaces-Results from an Integrative Literature Review

Background: The aim of the present study was to obtain an overview of occupational safety culture by assessing and mapping determinants in different workplaces (hospital workplaces and workplaces in construction, manufacturing, and other industry sectors) using an already established theoretical framework with seven clusters developed by Cornelissen and colleagues. We further derived implications for further research on determinants of occupational safety culture for the hospital workplace by comparing the hospital workplace with other workplaces. Methods: We conducted an integrative literature review and searched systematically for studies in four research databases (PubMed, Web of Science, CINAHL, and PsycINFO). The search was undertaken in 2019, and updated in April 2020. Results of the included studies were analyzed and mapped to the seven clusters proposed by Cornelissen and colleagues. Results: After screening 5566 hits, 44 studies were included. Among these, 17 studies were conducted in hospital workplaces and 27 were performed in other workplaces. We identified various determinants of an occupational safety culture. Most studies in hospital and other workplaces included determinants referring to management and colleagues, to workplace characteristics and circumstances, and to employee characteristics. Only few determinants in the studies referred to other factors such as socio-economic factors or to content relating to climate and culture. Conclusions: The theoretical framework used was helpful in classifying various determinants from studies at different workplaces. By comparing and contrasting results of studies investigating determinants at the hospital workplace with those addressing other workplaces, it was possible to derive implications for further research, especially for the hospital sector. To date, many determinants for occupational safety culture known from workplaces outside of the healthcare system have not been addressed in studies covering hospital workplaces. For further studies in the hospital workplace, it may be promising to address determinants that have been less studied so far to gain a more comprehensive picture of important determinants of an occupational safety culture in the hospital sector.

What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes

OBJECTIVE

The purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes.

METHODS

A cross-sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post-traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non-responder survey was conducted to asses for demographic differences in those who did and did not complete the survey.

RESULTS

This survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes.

CONCLUSION

These findings illustrate that a host of different stressors may influence safety-related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.

Sleepiness and injury risk in emergency medical service workers in Taiwan

BACKGROUND

Insufficient sleep is a common health and safety risk factor in high-impact workplaces where workers are required to take rotating shifts. However, studies on sleepiness-related risks and incidents, particularly among emergency medical services (EMS) workers are limited.

OBJECTIVE

This study sought to investigate the prevalence of sleepiness and related workplace incidents among EMS workers.

METHODS

This study utilized a cross-sectional survey design on a convenient sample of 500 EMS workers from 41 EMS squads across Taiwan. Data were collected using structured online questionnaires on workplace sleepiness and related safety incidents based on the Epworth Sleepiness Scale (ESS) and a modified 25-item EMS Safety Inventory respectively.

RESULTS

With a response rate of 79.8% (n = 399), 36.9% of the respondents were identified as having mild daytime sleepiness, while 39.2% of the respondents were identified as having excessive daytime sleepiness. Multivariate analysis indicated that not only was working on rotating shifts the main cause of the high ESS scores among EMS workers, but also that higher ESS scores increased their risk of sustaining a workplace injury. Furthermore, ill-at-work incidents were associated with an increased risk of workplace-related injuries.

CONCLUSION

Overall, the findings indicated a correlation among working on rotation shifts, the prevalence of sleepiness, and a higher risk of workplace injury among EMS workers.

The evaluation of an ambulance rear compartment using patient simulation: Issues of safety and efficiency during the delivery of patient care

The purpose of this study was to evaluate the safety and efficiency of a specific ambulance while providers delivered basic and advanced life support. Forty-eight, Emergency Medical Service (EMS) teams were observed delivering care to a simulated patient during an anaphylaxis scenario in a moving ambulance that contained a complete compliment of medical supplies and equipment. A detailed coding system was developed and applied to the audio and video behavioural data. Patterns of interaction among EMS personnel, the patient, equipment and the ambulance interior during the patient simulation scenario were analyzed. The results revealed a number of issues associated with the patient compartment including: potentially unsafe seated and standing positions; hazardous barriers to movement around the patient; difficulties accessing equipment and supplies; and the adequacy of work surfaces and waste disposal. A number of design recommendations are made to guide provider and patient comfort, efficiency and safety.

Burnout and safety outcomes - a cross-sectional nationwide survey of EMS-workers in Germany

Background

The association between burnout and patient safety has been analyzed in many studies for nurses, physicians, and residents. However, studies concerning prehospital emergency medical services (EMS) workers are limited, although they are particularly under risk for emotional stress. This study aims to descriptively analyze the overall degree of burnout among EMS-workers, and potential adverse events that might harm patients as well as the relationship between burnout and perceived safety outcomes for EMS-workers in Germany.

Methods

EMS-workers were recruited via German EMS-journals, social media and a professional association to participate in an online survey. The questionnaire includes the ´Maslach Burnout Inventory´ (MBI), the ‘Emergency Medical Services Safety Inventory’ (EMS-SI), and items about job satisfaction and the individual person. Data was descriptively analyzed by calculating frequencies, means, percentages and Pearson correlation coefficients. The association between burnout and patient safety was analyzed using linear and logistic regression models.

Results

A total of n = 1101 questionnaires were considered for data analysis. The vast majority of participants were male, younger than 40 years old, and full-time employees with an EMS-experience of 12 years on average. Between 19.9 and 40% of the participants showed a high degree of burnout in one of the burnout dimensions. Safety compromising behavior was the outcome measure with the highest percentage of participants reporting a negative outcome measure. The dimensions emotional exhaustion and depersonalization were positively associated with the safety outcomes injury and safety compromising behavior. Additionally, experiences, job satisfaction and the intention to leave the current job were significantly associated with the outcome measures.

Conclusion

This is the first study that examines the association between the degree of burnout and patient safety for EMS-workers. The results suggest that an expansion of psychological support for EMS-workers should be considered. Further research should concentrate on the complex relations between working conditions, burnout and patient safety.

Electronic supplementary material

The online version of this article (10.1186/s12873-018-0177-2) contains supplementary material, which is available to authorized users.

Supporting a Culture of Health in the Workplace: A Review of Evidence-Based Elements

OBJECTIVE

To identify and evaluate the evidence base for culture of health elements.

DATA SOURCE

Multiple databases were systematically searched to identify research studies published between 1990 and 2015 on culture of health elements.

STUDY INCLUSION AND EXCLUSION CRITERIA

Researchers included studies based on the following criteria: (1) conducted in a worksite setting; (2) applied and evaluated 1 or more culture of health elements; and (3) reported 1 or more health or safety factors.

DATA EXTRACTION

Eleven researchers screened the identified studies with abstraction conducted by a primary and secondary reviewer. Of the 1023 articles identified, 10 research reviews and 95 standard studies were eligible and abstracted.

DATA SYNTHESIS

Data synthesis focused on research approach and design as well as culture of health elements evaluated.

RESULTS

The majority of published studies reviewed were identified as quantitative studies (62), whereas fewer were qualitative (27), research reviews (10), or other study approaches. Three of the most frequently studied culture of health elements were built environment (25), policies and procedures (28), and communications (27). Although all studies included a health or safety factor, not all reported a statistically significant outcome.

CONCLUSIONS

A considerable number of cross-sectional studies demonstrated significant and salient correlations between culture of health elements and the health and safety of employees, but more research is needed to examine causality.

Patient Safety Culture in Slovenian out-of-hours Primary Care Clinics

Introduction

Patient safety culture is a concept which describes how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. We aimed to investigate patient safety culture in Slovenian out-of-hours health care (OOHC) clinics, and determine the possible factors that might be associated with it.

Methods

This was a cross-sectional study, which took place in Slovenian OOHC, as part of the international study entitled Patient Safety Culture in European Out-of-Hours Services (SAFE-EUR-OOH). All the OOHC clinics in Slovenia (N=60) were invited to participate, and 37 agreed to do so; 438 employees from these clinics were invited to participate. We used the Slovenian version of the Safety Attitudes Questionnaire – an ambulatory version (SAQAV) to measure the climate of safety.

Results

Out of 438 invited participants, 250 answered the questionnaire (57.1% response rate). The mean overall score ± standard deviation of the SAQ was 56.6±16.0 points, of Perceptions of Management 53.6±19.6 points, of Job Satisfaction 48.5±18.3 points, of Safety Climate 59.1±22.1 points, of Teamwork Climate 72.7±16.6, and of Communication 51.5±23.4 points. Employees working in the Ravne na Koroškem region, employees with variable work shifts, and those with full-time jobs scored significantly higher on the SAQ-AV.

Conclusion

The safety culture in Slovenian OOHC clinics needs improvement. The variations in the safety culture factor scores in Slovenian OOHC clinics point to the need to eliminate variations and improve working conditions in Slovenian OOHC clinics.

Understanding emergency workers' behavior and perspectives on design and safety in the workplace

Emergency Medical Services (EMS) is a demanding and hazardous industry. Because of the changing roles in the emergency response system, EMS workers are increasingly expected to provide treatment and care in addition to transport, which increases their task load and susceptibility to harm. This paper serves to outline the EMS field from the worker's perspective with the purpose of understanding their views on health, safety, and the work environment, and identify where gaps in worker well-being are exposed. Through direct observation, field studies, and formal interviews with EMS professionals, we discuss where reluctance lies in addressing safety issues and the current efforts to address them. A high prevalence of responses regarding the inadequacy of ambulance restraining systems was reported, as existing interventions do not take into account medic needs.

An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers

OBJECTIVES

Emergency medical services (EMS) clinicians are shift workers deployed in two-person teams. Extended shift duration, workplace fatigue, poor sleep and lack of familiarity with teammates are common in the EMS workforce and may contribute to workplace injury. We sought to examine the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors.

METHODS

We obtained 3 years of shift schedules and occupational injury and illness reports were from 14 large EMS agencies. We abstracted shift length and additional scheduling and team characteristics from shift schedules. We matched occupational injury and illness reports to shift records and used hierarchical logistic regression models to test the relationship between shift length and occupational injury and illness while controlling for teammate familiarity.

RESULTS

The cohort contained 966,082 shifts, 4382 employees and 950 outcome reports. Risk of occupational injury and illness was lower for shifts ≤8 h in duration (RR 0.70; 95% CI 0.51 to 0.96) compared with shifts >8 and ≤12 h. Relative to shifts >8 and ≤12 h, risk of injury was 60% greater (RR 1.60; 95% CI 1.22 to 2.10) for employees that worked shifts >16 and ≤24 h.

CONCLUSIONS

Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers.

Resiliency Improvements in Medical Emergency Staff in Burn Missions: A Qualitative Study in an Iranian Context

BACKGROUND

Medical emergency staff complete understanding of the nature of resiliency in burn events is a prerequisite for improving the quality of clinical service delivery in pre-hospital burn events.

OBJECTIVES

The present study aimed to describe resiliency in view of medical emergency staff in burn events.

MATERIALS AND METHODS

The present qualitative study was performed using a content analysis method. In total, 18 Iranian emergency care personnel participated in the study. A purposeful sampling method was applied until reaching data saturation. Data was collected using semi-structured interviews and field observations. Afterwards, data was analyzed by face content analysis.

RESULTS

By analyzing 456 primary codes, four main concepts including: 1) scene safety/security, 2) effective clinical decision making, 3) self-efficacy and 4) religious support were extracted through content analysis from experiences of pre-hospital emergency personnel during burn care.

CONCLUSIONS

Different factors affect resiliency improvements in medical emergency staff and consequently the quality of pre-hospital burn care. This study showed that various factors such as scene security/safety, effective decision making, self-efficacy and religious support are effective in the improvement of resiliency and the quality of pre-hospital emergency care.

Mobile phone text messaging intervention to improve alertness and reduce sleepiness and fatigue during shiftwork among emergency medicine clinicians: study protocol for the SleepTrackTXT pilot randomized controlled trial

Background

Mental and physical fatigue while at work is common among emergency medical services (EMS) shift workers. Extended shifts (for example 24 hours) and excessive amounts of overtime work increase the likelihood of negative safety outcomes and pose a challenge for EMS fatigue-risk management. Text message-based interventions are a potentially high-impact, low-cost platform for sleep and fatigue assessment and distributing information to workers at risk of negative safety outcomes related to sleep behaviors and fatigue.

Methods/Design

We will conduct a pilot randomized trial with a convenience sample of adult EMS workers recruited from across the United States using a single study website. Participants will be allocated to one of two possible arms for a 90-day study period. The intervention arm will involve text message assessments of sleepiness, fatigue, and difficulty with concentration at the beginning, during, and end of scheduled shifts. Intervention subjects reporting high levels of sleepiness or fatigue will receive one of four randomly selected intervention messages promoting behavior change during shiftwork. Control subjects will receive assessment only text messages. We aim to determine the performance characteristics of a text messaging tool for the delivery of a sleep and fatigue intervention. We seek to determine if a text messaging program with tailored intervention messages is effective at reducing perceived sleepiness and/or fatigue among emergency medicine clinician shift workers. Additional aims include testing whether a theory-based behavioral intervention, delivered by text message, changes ‘alertness behaviors’.

Discussion

The SleepTrackTXT pilot trial could provide evidence of compliance and effectiveness that would support rapid widespread expansion in one of two forms: 1) a stand-alone program in the form of a tailored/individualized sleep monitoring and fatigue reduction support service for EMS workers; or 2) an add-on to a multi-component fatigue risk management program led and maintained by employers or by safety and risk management services.

Trial Registration

Clinicaltrials.gov NCT02063737, Registered on 10 January 2014

Measuring adverse events in helicopter emergency medical services: establishing content validity

INTRODUCTION

We sought to create a valid framework for detecting adverse events (AEs) in the high-risk setting of helicopter emergency medical services (HEMS).

METHODS

We assembled a panel of 10 expert clinicians (n = 6 emergency medicine physicians and n = 4 prehospital nurses and flight paramedics) affiliated with a large multistate HEMS organization in the Northeast US. We used a modified Delphi technique to develop a framework for detecting AEs associated with the treatment of critically ill or injured patients. We used a widely applied measure, the content validity index (CVI), to quantify the validity of the framework's content.

RESULTS

The expert panel of 10 clinicians reached consensus on a common AE definition and four-step protocol/process for AE detection in HEMS. The consensus-based framework is composed of three main components: (1) a trigger tool, (2) a method for rating proximal cause, and (3) a method for rating AE severity. The CVI findings isolate components of the framework considered content valid.

CONCLUSIONS

We demonstrate a standardized process for the development of a content-valid framework for AE detection. The framework is a model for the development of a method for AE identification in other settings, including ground-based EMS.

Patient safety perceptions of primary care providers after implementation of an electronic medical record system

BACKGROUND

Increasing the use of electronic medical records (EMR) has been suggested as an important strategy for improving healthcare safety.

OBJECTIVE

To sequentially measure, evaluate, and respond to safety culture and practice safety concerns following EMR implementation.

DESIGN

Safety culture was assessed using a validated tool (Safety Attitudes Questionnaire; SAQ), immediately following EMR implementation (T1) and at 1.5 (T2) and 2.5 (T3) years post-implementation. The SAQ was supplemented with a practice-specific assessment tool to identify safety needs and barriers.

PARTICIPANTS

A large medical group practice with a primary care core of 17-18 practices, staffed by clinicians in family medicine, pediatrics, internal medicine.

INTERVENTIONS

Survey results were used to define and respond to areas of need between assessments with system changes and educational programs.

MAIN MEASURES

Change in safety culture over time; perceived impact of EMR on practice.

KEY RESULTS

Responses were received from 103 of 123 primary care providers in T1 (83.7 % response rate), 122 of 143 in T2 (85.3 %) and 142 of 181 in T3 (78.5 %). Safety culture improved over this period, with statistically significant improvement in all domains except for stress recognition. Time constraints, communications and patient adherence were perceived to be the most important safety issues. The majority of respondents in both T2 (77.9 %) and T3 (85.4 %) surveys agreed that the EMR improved their ability to provide care more safely.

CONCLUSIONS

Implementation of an EMR in a large primary care practice required redesign of many organizational processes, and was associated with improvements in safety culture. Most primary care providers agreed that the EMR allowed them to provide care more safely.

The emergency medical services safety champions

The overarching mission of prehospital emergency medical services (EMS) is to deliver lifesaving care for people when their needs are greatest. Fulfilling this mission is challenged by threats to patient and provider safety. The EMS setting is a high-risk one because care is delivered rapidly in the out-of-hospital setting where resources of benefit to patients are limited. There is growing evidence that safety culture varies widely across EMS agencies. A poor safety culture may manifest as error in medication, back injuries, and other poor outcomes for patient and provider. Recently, federal and national leaders of EMS (ie, the National Highway Traffic Safety Administration) have made improving EMS safety culture a national priority. Unfortunately, few initiatives can help local EMS leaders achieve that priority. The authors describe the successful EMS Champs Fellowship program, supported by the Jewish Healthcare Foundation, designed to train EMS leaders to improve safety for patients and providers.