Factors influencing the perception of feeling safe in pre‐hospital emergency care: A mixed‐methods systematic review

Abstract

Aims: To systematically describe the factors influencing the perception of feeling safe among patients receiving pre-hospital emergency care. Background: Patient safety is a top priority worldwide. Little is known about how patients perceive safety during emergency health care and what the related factors are. Design: A mixed-methods systematic review.Methods: Six databases were searched to December 2021. Inclusion criteria were as follows: studies with patients of any age, framed in pre-hospital emergency care settings, referring to patient safety, addressing the perception of safety, and with a quantitative or qualitative research design. Exclusion criteria were as follows: conference records, abstracts, supplements, letters, editorials and reviews. The quality of the evidence was assessed with the Joanna Briggs Institute (JBI) checklists. A convergent integrated approach was followed according to the JBI methodology. The protocol was registered on PROSPERO (CRD42022306337). PRISMA 2020 guidelines were followed in reporting this review.Results: Among the 5223 records identified, the whole texts of 35 articles were reviewed. Ten studies were relevant to the research question. Seven followed a qualitative methodology, with interviews or focus group. Three involved a quantitative methodology, with questionnaires or validated measures. The 74 findings were organised into 11 categories and then grouped into four dimensions: 'receiving a satisfying response from healthcare professionals when I need it', 'EMS personnel's professional competence', 'the variable and unfamiliar settings of pre-hospital emergencies', and 'patients' personal characteristics'. Conclusions:The perception of safety is influenced by many factors, which can be grouped into four independent dimensions. Quantitative and qualitative studies can provide us with complementary findings. Scopus (emotions OR feeling OR perception OR experience) AND ("patient safety" OR safe OR safety) AND (ambulances OR "emergency medical services" OR "prehospital emergency care") Web of Science (WOS) (emotions OR feeling OR perception OR experience) AND ("patient safety" OR safe OR safety) AND (ambulances OR "emergency medical services" OR "prehospital emergency care") PsycInfo (emotions OR feeling OR perception OR experience) AND ("patient safety" OR safe OR safety) AND (ambulances OR "emergency medical services" OR "prehospital emergency care")

Factors related to patients’ perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study

“…Este resultado, aunque es razonable, como se ha demostrado en el ámbito hospitalario 23 , no se había cuantificado en el ámbito de emergencias extrahospitalarias. En los estudios sobre factores relacionados con la percepción de seguridad, los participantes no hicieron ninguna referencia a IRSP 13 . En el ámbito hospitalario, Armitage et al 24 detectaron que los pacientes podían reportar IRSP, que en la mayoría de los casos no aparecían en otros registros de incidentes, porque su visión subjetiva era única.…”

“…En emergencias extrahospitalarias, una revisión sistemática de modelos mixtos identificó factores compartidos por los diseños cualitativos y cuantitativos 13 , pero también algunos factores que sólo aparecían en las entrevistas o grupos focales, y otros que sólo aparecían en los estudios con escalas validadas 14 . En este medio extrahospitalario se dispone de la Escala de Seguridad Percibida (ESP16), que se ha validado para pacientes asistidos/trasladados en emergencias 15 .…”

Prevalence and clustering of NANDA‐I nursing diagnoses in the pre‐hospital emergency care setting: A retrospective records review study

“…The coping/stress tolerance domain diagnoses Anxiety ( 00146 ) and Fear ( 00148 ) are not only in the top five diagnoses recorded in this study but also appear in 41.4% of all episodes studied. The literature describes the association between these human responses and the perception of feeling safe (Péculo‐Carrasco et al., 2020, 2022) and with typical symptoms in patients assisted by emergency teams, such as dyspnea, acute or chronic pain (Kauppi et al., 2020; Lourens et al., 2019). Both diagnoses are equally present in patients cared for in different clinical settings (Mercês et al., 2021), such as intensive care units (Ferreira et al., 2016), obstetrics (Yang et al., 2019) and surgery (Noh & Lee, 2014), also, in multi‐pathological patients (Villarejo, 2011) or with COVID‐19 (Swanson et al., 2020).…”

“…Pre‐hospital care is defined as the care and treatment given to people in danger of death due to an accident or sudden acute illness that needs to be transferred by ambulance or helicopter to health care facilities, such as the hospital emergency department (Ahl & Nyström, 2012; Péculo‐Carrasco et al., 2022; Tibães et al., 2018). Pre‐hospital emergency medical services (EMS) have evolved considerably since their beginnings (Coca et al., 2020).…”

Finnish emergency medical services managers’ and medical directors’ perceptions of collaborating with patients concerning patient safety issues: a qualitative study

“…Patient safety studies in an EMS setting mainly focus on adverse events, near-misses, occupational hazards, or the safety of the non-conveyance decisions focusing primarily on an organisational or EMS personnel perspective 5 10 14–18. Patients’ perceptions of safety in the EMS have been studied; the findings show that patients’ perceptions of safety in the EMS are not the same as receiving safe care 7 19 20. However, little is known about how EMS organisations use patients’ experiences when developing patient safety in EMS, despite global guidelines recommending increasing patient participation when developing patient safety 13 21…”