Epidemiology of Preventable Safety Events in Prehospital EMS for Children

描述(申请人提供)：安全是与儿童有关的紧急服务的高质量护理的先决条件。院外急救期间发生的安全事件知之甚少，缺乏高质量的流行病学数据。背景：虽然已经分析了医院环境中的质量和安全问题，但院前急救服务中的安全事件尚未得到评估。新技术为开展流行病学和模拟研究提供了前所未有的机会。目的：1)确定院前儿童急救中安全事件的可靠和有效的措施；2)了解儿童院前急救中安全事件的发生率和影响因素；3)了解在现场模拟儿童突发事件中导致安全事件的个人、团队和系统问题；4)建立一个国家安全事件匿名报告系统。方法：我们将首先与急救医疗服务人员和急诊科提供者组成焦点小组，以确定EMS儿童护理中安全事件的范围和贡献者的特征。反过来，一个专家小组将对被认为是安全事件(如复苏、癫痫发作、灯光和警报器运输)高风险病例的随机抽样进行审查，以开发筛选和评估工具。这些工具将用于筛选大都市地区1年的儿科EMS运输情况，以确定安全事件。所有筛查阳性记录将由专家小组使用结构化工具进行审查，以确认安全事件并评估促成因素和可预防性。在一种免费的方法中，将使用患者模拟来评估安全事件发生的过程。最后，我们将开发一个基于网络的报告系统，以捕获所有EMS系统中的广泛安全事件：其中一些事件可能在电子记录中很少见或无法检测到。意义：这一系列研究将利用新技术--电子记录、模拟和基于网络的报告--来全面了解与儿童院前护理有关的安全事件。查明导致安全事件的因素将有助于改进培训和实施保障措施，以确保紧急护理中的儿科安全和质量。 公共卫生相关性：在将儿童送往医院的过程中发生的紧急护理安全事件尚未得到评估。这项研究将使用专家小组评审、电子EMS数据分析和患者模拟来衡量在儿童院前护理中发生的安全事件的数量和类型。查明导致安全事件的因素将有助于改进培训和实施保障措施，以确保紧急护理中的儿科安全和质量。

DESCRIPTION (provided by applicant): Safety is the prerequisite element to quality care for emergency services relating to children. Safety events occurring during the emergency medical care outside the hospital are poorly understood and high quality epidemiologic data are lacking. Background: While quality and safety issues have been analyzed in the hospital setting, safety events have not been evaluated in emergency prehospital services. New technologies provide unprecedented opportunities to conduct epidemiologic and simulation studies. Aims: These studies aim to 1) identify reliable and valid measures for safety events in the prehospital care of children, 2) understand the incidence and contributors to safety events in the prehospital care for children, 3) understand individual, team, and systems issues that lead to safety events during in situ simulation of children's emergencies, and 4) establish a national system for the anonymous reporting of safety events. Methods: We will begin by conducting focus groups with Emergency Medical Services personnel and Emergency Department providers to characterize the range of and contributors to safety events in the EMS care of children. In turn, an expert panel will review a random sample of cases thought to be at high risk for a safety event (e.g., resuscitation, seizures, lights and siren transport) to develop screening and evaluation tools. These tools will be used to screen 1 year of pediatric EMS transports in a metropolitan area to identify safety events. All screen-positive records will be reviewed by an expert panel using a structured tool to confirm the safety event and assess contributing factors and preventability. In a complimentary approach, patient simulations will be used to evaluate the process by which safety events occur. Finally, we will develop a web-based reporting system to capture a broad range of safety events across all EMS systems: some of these events may be rare or undetectable in electronic records. Significance: This series of studies will exploit new technologies -- electronic records, simulation, and web-based reporting -- to develop a comprehensive understanding of safety events relating to the prehospital care of children. Identification of the factors contributing to safety events will inform improvements in training and implementation of safeguards to assure pediatric safety and quality in emergency care. PUBLIC HEALTH RELEVANCE: Safety events occurring in the emergency care of children during transports to the hospital have not been evaluated. This study will use expert panel reviews, analysis of electronic EMS data, and patient simulation to measure the numbers and types of safety events occurring in the prehospital care of children. Identification of the factors contributing to safety events will inform improvements in training and implementation of safeguards to assure pediatric safety and quality in emergency care.