The patient safety practices of emergency medical teams in disaster zones: a systematic analysis
The patient safety practices of emergency medical teams in disaster zones: a systematic analysis
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DOI：
10.1136/bmjgh-2019-001889
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发表时间：
2019-11-01
影响因子：
8.1
通讯作者：
Darzi, Ara
中科院分区：
文献类型：
--
作者：
El-khani, Ussamah;Ashrafian, Hutan;Darzi, Ara
灾区医疗救援一直被批评为质量差的护理，缺乏标准化和问责制。灾区急救医疗队（EMT）的传统患者安全实践尚未得到很好的理解。提高灾区的医疗质量在全球卫生政策中变得越来越重要。确定在灾区的EMT患者安全的做法，可以确定的做法，可以改进的领域。方法OvidSP，Embase和Medline数据库的系统搜索;关键期刊的利益;关键的灰色文献文本;世界卫生组织，无国界医生组织和红十字国际委员会的数据库;和谷歌学术进行。描述性研究，病例报告，病例系列，前瞻性试验和意见片包括日期或publish.Results语言没有限制有9685条记录，均匀分布在同行评议和灰色文献之间。其中，30项研究和9篇灰色文献文本符合纳入标准，并进行了定性综合。从这些文章中，提取了302份患者安全性声明。主位分析将这些陈述分为84个主位（总频率632）。最常见的主题是肢体损伤（9%），医疗记录（5.4%），手术决策（4.6%），药品安全（4.4%）和协议（4.4%）。结论在灾区EMT的患者安全实践侧重于急性临床护理，特别是手术。非传染性疾病管理的代表性不足。人们普遍认识到需要改进医疗记录的保存。缺乏高质量的数据和机构层面的患者安全实践。对于具体的灾区业绩指标没有达成共识。这些缺陷代表了改善灾区患者安全的机会。
Introduction Disaster zone medical relief has been criticised for poor quality care, lack of standardisation and accountability. Traditional patient safety practices of emergency medical teams (EMTs) in disaster zones were not well understood. Improving the quality of healthcare in disaster zones has gained importance within global health policy. Ascertaining patient safety practices of EMTs in disaster zones may identify areas of practice that can be improved.Methods A systematic search of OvidSP, Embase and Medline databases; key journals of interest; key grey literature texts; the databases of the WHO, Medecins Sans Frontieres and the International Committee of the Red Cross; and Google Scholar was performed. Descriptive studies, case reports, case series, prospective trials and opinion pieces were included with no limitation on date or language of publication.Results There were 9685 records, evenly distributed between the peer-reviewed and grey literature. Of these, 30 studies and 9 grey literature texts met the inclusion criteria and underwent qualitative synthesis. From these articles, 302 patient safety statements were extracted. Thematic analysis categorised these statements into 84 themes (total frequency 632). The most frequent themes were limb injury (9%), medical records (5.4%), surgery decision-making (4.6%), medicines safety (4.4%) and protocol (4.4%).Conclusion Patient safety practices of EMTs in disaster zones are weighted toward acute clinical care, particularly surgery. The management of non-communicable disease is under-represented. There is widespread recognition of the need to improve medical record-keeping. High-quality data and institutional level patient safety practices are lacking. There is no consensus on disaster zone-specific performance indicators. These deficiencies represent opportunities to improve patient safety in disaster zones.