Epidemiology of Preventable Safety Events in Prehospital EMS for Children

描述（由申请人提供）：安全是与儿童有关的紧急服务的质量护理的先决条件。对院外急救医疗期间发生的安全事件了解甚少，缺乏高质量的流行病学数据。背景资料：虽然已经在医院环境中分析了质量和安全问题，但尚未对紧急院前服务中的安全事件进行评估。新技术为进行流行病学和模拟研究提供了前所未有的机会。目的：这些研究旨在：1）确定儿童院前护理中安全事件的可靠有效措施，2）了解儿童院前护理中安全事件的发生率和促成因素，3）了解在儿童紧急情况现场模拟期间导致安全事件的个人、团队和系统问题，以及4）建立安全事件匿名报告的国家系统。研究方法：我们将开始与紧急医疗服务人员和急诊科提供者进行焦点小组讨论，以描述儿童EMS护理中安全事件的范围和促成因素。反过来，专家小组将审查被认为具有安全性事件高风险的病例的随机样本（例如，复苏、癫痫发作、灯光和警报器运输），以开发筛查和评估工具。这些工具将用于筛查大都市地区1年的儿科EMS运输，以识别安全事件。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影响因素和可预防性。在一种补充方法中，将使用患者模拟来评价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：其中一些事件可能很罕见或在电子记录中无法检测到。重要性：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-以全面了解与儿童院前护理有关的安全事件。识别导致安全性事件的因素将有助于改进培训和实施保障措施，以确保儿科急诊护理的安全性和质量。 公共卫生相关性：尚未对儿童在送往医院途中的紧急护理中发生的安全性事件进行评价。本研究将使用专家小组审查、电子EMS数据分析和患者模拟来测量儿童院前护理中发生的安全性事件的数量和类型。识别导致安全性事件的因素将有助于改进培训和实施保障措施，以确保儿科急诊护理的安全性和质量。

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.