National EMS Patient Safety Reporting System

描述（由申请人提供）：没有关于紧急医疗服务（EMS）护理过程中发生的错误、未遂和不良事件的具体数据。最近医学研究所关于医疗错误的报告发现，急诊医学（EM）在医学专业中具有最高的可预防不良事件发生率。虽然院前医疗还没有被研究过，但我们可以合理地预计，EMS与EM相似，并且具有更多已知的使EM具有高风险错误的特征，也具有较高的不良事件发生率。此外，在美国，每年有2500万患者接受紧急医疗服务，因此，在这种环境下，美国公众面临的医疗差错风险是巨大的。消除不良事件必须是EMS系统的优先事项，以确保医疗质量。为了提高EMS中的患者安全，必须明确了解EMS中发生的医疗差错、未遂事故和不良事件的性质。实时事件报告系统是一种经过验证的有效手段，可以快速可靠地获取有关此类事件的信息。以成功的航空安全报告系统（ASRS）为蓝本的报告系统已被证明在包括退伍军人管理局（VA）医院在内的非航空、健康相关环境中发挥了有效的作用。一些针对医院的商业事件报告系统已经非常成功。这些系统都不能满足EMS的独特需求，但它们证明了需要商业系统和商业成功的潜力。医疗错误预防和报告系统（MEPARS）是唯一已知的基于ASRS原则设计的针对EMS的商业错误报告系统。MEPARS的本地特定机构版本已经在一家EMS机构进行了试点测试，在识别和消除错误方面取得了显著的成功。拟议的第一期项目的总体目标是完善和扩展MEPARS，并通过在大型城市/郊区EMS系统中实施该系统来测试其可行性。在该项目结束时，将建立一个基础设施，使MEPARS系统能够在全国范围内轻松实施。由此产生的数据库将使研究人员能够更好地了解EMS中医疗差错的本质，从而设计干预措施和系统变更，以最大限度地减少这些差错造成的不良事件。

DESCRIPTION (provided by applicant): Specific data on errors, near misses, and adverse events occurring during emergency medical services (EMS) care do not exist. The recent Institute of Medicine report on medical error found emergency medicine (EM) to have the highest rate of preventable adverse events among the medical specialties. Although prehospital medical care has not been studied, it is reasonable to expect that EMS, which is similar to EM and has even more of the characteristics that are known to place EM at high risk for error, also has a high rate of adverse events. Moreover, 25 million patients receive EMS care annually in the US, so that the exposure of the US public to risk of medical error in this environment is substantial. Eliminating adverse events must be a priority for EMS systems to ensure quality medical care. To improve patient safety in EMS a clear understanding of the nature of the medical errors, near misses, and adverse events that occur in EMS must be developed. Real-time event reporting systems represent one proven and effective means of acquiring information about such events in a rapid and reliable fashion. Use of a reporting system modeled after the successful Aviation Safety Reporting System (ASRS) has been demonstrated to be effective in this role in non-aviation, health-related settings including Veterans' Administration (VA) hospitals. Several commercial event reporting systems for hospitals have become very successful. None of these systems satisfy the unique needs of EMS, but they serve as evidence that there is a need for commercial systems and potential for commercial success. The Medical Error Prevention and Reporting System (MEPARS) is the only known commercial error reporting system designed on the principles of the ASRS and targeted for EMS. A local, agency-specific version of MEPARS has been pilot tested at one EMS agency, with notable successes in identifying and eliminating errors. The overall objective of the proposed Phase I project is to refine and expand MEPARS and test its feasibility by implementing the system in a large urban/suburban EMS system. At the conclusion of this project, an infrastructure will be in place that will allow the MEPARS system to easily be implemented nationwide. The resulting database will allow researchers to gain a better understanding of the nature of medical error in EMS, and thus design interventions and system changes to minimize adverse events as a result of these errors.