Application of the emergency medical services trigger tool to measure adverse events in prehospital emergency care: a time series analysis

Abstract

BackgroundEmergency Care has previously been identified as an area of significant concern regarding the prevalence of Adverse Events (AEs). However, the majority of this focus has been on the in-hospital setting, with little understanding of the identification and incidence of AEs in the prehospital environment.MethodThe early development and testing of Emergency Medical Services (EMS) specific triggers for the identification of AEs and Harm has been previously described. To operationalise the Emergency Medical Services Trigger Tool (EMSTT), the processes developed by the Institute for Healthcare Improvement for use with the Global Trigger Tool were adapted to a prehospital emergency care setting. These were then applied using a stepwise approach to the analysis of 36 consecutive samples of patient care records over an 18-month period (n = 710). Inter-rater reliability was measured for each trigger item and level of Harm classification. Total Triggers per 10,000 Patient Encounters, AEs per 10,000 Patient Encounters and Harm per 10,000 Patient Encounters were measured. All measures were plotted on Statistical Process Control Charts.ResultsThere was a high level of inter-rater agreement across all items (range: 85.6–100%). The EMSTT found an average rate of 8.20 Triggers per 10,000 Patient Encounters, 2.48 AEs per 10,000 Patient Encounters and 0.34 Harm events per 10,000 Patient Encounters. Three triggers: Change in Systolic Blood Pressure Greater Than 20%; Temp > 38 °C without subsequent reduction; and SpO2 < 94% without supplemental Oxygen or SpO2 < 85% without assisted ventilation accounted for 93% (n = 180) of the triggers found throughout the longitudinal analysis.DiscussionWith sufficient focus on implementation and data collection, as well as the inclusion of a contextually relevant system for classifying AE/Harm, the EMSTT represents a potentially successful strategy towards identifying the rate of AEs within EMS across a large patient population with limited commitment of time and resources.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0195-0) contains supplementary material, which is available to authorized users.

Segurança Do Paciente Na Assistência Pré-Hospitalar De Emergência / Patient Safety in Pre-Hospital Emergency Care

“…Por fim, Damiani 2017 Sobre as Ferramentas de "gatilho", que seriam metodologias baseadas em evidências (sinais e sintomas específicos) que auxiliariam no cuidado em APH, discutese que tal metodologia figura como um método rápido, confiável e simples, mas abrangente de detectar Eventos Adversos (EAs) na área da saúde. Com um melhor entendimento dos tipos de casos e causas de EAs e danos, projetos de melhoria direcionados podem ser projetados e implementados para melhorar a qualidade e a segurança do paciente (HOWARD et al, 2018).…”

Trigger tool-based description of adverse events in helicopter emergency medical services in Qatar

“…The first 3 months of data, from 1 August 2016 to 31 October 2016, were excluded to account for potential inconsistencies that may have existed in applying the inclusion and exclusion criteria, and uniformity in application of the PittAETool 28. This sample size is mirrored in similar recent published research 30 31…”

Understanding quality systems in the South African prehospital emergency medical services: a multiple exploratory case study

“…[1][2][3][4] As PEC focused tools for measuring and understanding patient safety and quality of care have been developed and implemented, so too has the recognition of the importance of formal systems for governing such activities. [4][5][6][7][8][9] In South Africa (SA), a mix of governmentfunded and private emergency medical services (EMS) deliver PEC across the country. 10 Within these services, quality systems are in their infancy.…”