Understanding safety in prehospital emergency medical services for children.
Understanding safety in prehospital emergency medical services for children.
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DOI：
10.3109/10903127.2013.869640
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发表时间：
2014-07
影响因子：
2.4
通讯作者：
Guise JM
中科院分区：
文献类型：
--
作者：
Cottrell EK;O'Brien K;Curry M;Meckler GD;Engle PP;Jui J;Summers C;Lambert W;Guise JM
十多年来，医学界已经认识到研究和设计预防医院和诊所安全问题的战略的重要性。然而，对于院前急救服务的安全性，特别是对儿童的安全性，人们的关注较少。每年约有2,770万人次(或27%)的急症室就诊是19岁以下的儿童，其中约200万名儿童是通过急救服务到达医院的。本文增加了我们对儿童院前急救中安全事件的性质和影响因素的定性理解。我们在付费和志愿紧急医疗服务提供者中进行了四个8-12人的焦点小组，以了解：1)在儿童的院前护理中发生的患者安全问题，以及2)导致这些安全问题的因素(例如，患者、家庭、系统、环境或个人提供者因素)。在农村和城市环境中开展了重点小组活动。采访记录是针对主要主题进行编码的。分析中确定的关键因素和主题使用生态方法进行分类，该方法区分系统、团队、儿童和家庭以及个人提供者级别的贡献者。在系统一级，焦点小组与会者列举了一些挑战，如缺乏适当大小的设备或标准化的儿科用药剂量、人力资源不足、儿科培训和经验有限以及紧急医疗服务文化方面。EMS团队层面的因素集中在与其他EMS提供者(院前和医院)的沟通上。家庭和儿童因素包括沟通障碍和具有挑战性的临床情况或场景特征。最后，焦点小组参与者强调了一系列提供者层面的因素，包括高度焦虑、对儿童的经验和培训不足以及评估和决策中的错误。我们的研究结果表明，就像医院医学一样，系统、团队、儿童/家庭和个人提供者层面的因素导致院前急救错误。这些因素可以通过干预和系统改进来改变。需要未来的研究来确定这些发现的概括性，并进一步完善潜在的机制。
For over a decade, the field of medicine has recognized the importance of studying and designing strategies to prevent safety issues in hospitals and clinics. However, there has been less focus on understanding safety in prehospital emergency medical services, particularly in regard to children. Roughly 27.7 million (or 27%) of the annual ED visits are by children under the age of 19, and about 2 million of these children reach the hospital via EMS. This paper adds to our qualitative understanding of the nature and contributors to safety events in the prehospital emergency care of children. We conducted four 8–12 person focus groups among paid and volunteer Emergency Medical Services providers to understand: 1) patient safety issues that occur in the prehospital care of children, and 2) factors that contribute to these safety issues (e.g. patient, family, systems, environmental, or individual provider factors). Focus groups were conducted in rural and urban settings. Interview transcripts were coded for overarching themes. Key factors and themes identified in the analysis were grouped into categories using an ecological approach that distinguishes between systems, team, child and family, and individual provider level contributors. At the systems level, focus group participants cited challenges such as lack of appropriately sized equipment or standardized pediatric medication dosages, insufficient human resources, limited pediatric training and experience, and aspects of emergency medical services culture. EMS team level factors centered on communication with other EMS providers (both prehospital and hospital). Family and child factors included communication barriers and challenging clinical situations or scene characteristics. Finally, focus group participants highlighted a range of provider level factors including heightened levels of anxiety, insufficient experience and training with children and errors in assessment and decision-making The findings of our study suggest that just as in hospital medicine, factors at the systems, team, child/family and individual provider level system contribute to errors in prehospital emergency care. These factors may be modifiable through interventions and systems improvements. Future studies are needed to ascertain the generalizability of these findings and further refine the underlying mechanisms.
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影响因子：
8
作者：
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通讯作者：
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影响因子：
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