PATIENT SAFETY IN EMERGENCY MEDICAL SERVICES: A SYSTEMATIC REVIEW OF THE LITERATURE
PATIENT SAFETY IN EMERGENCY MEDICAL SERVICES: A SYSTEMATIC REVIEW OF THE LITERATURE
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DOI：
10.3109/10903127.2011.621045
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发表时间：
2012-01-01
影响因子：
2.4
通讯作者：
Morrison, Laurie J.
中科院分区：
文献类型：
--
作者：
Bigham, Blair L.;Buick, Jason E.;Morrison, Laurie J.
背景资料。在住院环境中，来自医疗护理的可预防的伤害已被广泛记录。急救医疗服务(EMS)提供者在动态和充满挑战的环境中为患者提供护理；院前急救是一个错误和伤害风险较高的领域，但在患者安全文献中受到的关注相对较少。目标。为了确定EMS环境对患者安全的独特威胁以及减轻这些威胁的干预措施，我们完成了对文献的系统回顾。方法：研究方法。我们在MEDLINE、EMBASE和护理与相关健康文献的累积索引(CINAHL)中搜索由一个泛加拿大专家小组组成的关键EMS和患者安全术语的组合，使用的年限为1999至2011年。我们排除了评论、意见、信件、摘要和非英文出版物。两名研究人员对标题、摘要和全文进行了独立的分级筛选，对来源视而不见。我们使用Kappa统计量来检验评分者之间的一致性。任何分歧都是通过协商一致解决的。结果。我们检索了5959篇文章，其中88篇符合纳入标准，分为7个主题：不良事件和用药差错(22篇)、临床判断(13篇)、沟通(6篇)、地面车辆安全(9篇)、飞机安全(6篇)、设施间运输(16篇)和插管(16篇)。2篇为随机对照试验；其余为系统综述、前瞻性观察研究、回溯性数据库/图表综述、定性访谈或调查。标题、摘要和全文的kappa统计量，第一次分别为0.65、0.79和0.87，第二次分别为0.60、0.74和0.85。结论。我们发现在EMS中研究患者安全性的科学文献很少。需要研究来提高我们对问题的严重性和对患者安全的威胁的理解，并指导干预措施。
Background. Preventable harm from medical care has been extensively documented in the inpatient setting. Emergency medical services (EMS) providers care for patients in dynamic and challenging environments; prehospital emergency care is a field that represents an area of high risk for errors and harm, but has received relatively little attention in the patient safety literature. Objective. To identify the threats to patient safety unique to the EMS environment and interventions that mitigate those threats, we completed a systematic review of the literature. Methods. We searched MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for combinations of key EMS and patient safety terms composed by a pan-canadian expert panel using a year limit of 1999 to 2011. We excluded commentaries, opinions, letters, abstracts, and non-english publications. Two investigators performed an independent hierarchical screening of titles, abstracts, and full-text articles blinded to source. We used the kappa statistic to examine interrater agreement. Any differences were resolved by consensus. Results. We retrieved 5,959 titles, and 88 publications met the inclusion criteria and were categorized into seven themes: adverse events and medication errors (22 articles), clinical judgment (13), communication (6), ground vehicle safety (9), aircraft safety (6), interfacility transport (16), and intubation (16). Two articles were randomized controlled trials; the remainder were systematic reviews, prospective observational studies, retrospective database/chart reviews, qualitative interviews, or surveys. The kappa statistics for titles, abstracts, and full-text articles were 0.65, 0.79, and 0.87, respectively, for the first search and 0.60, 0.74, and 0.85 for the second. Conclusions. We found a paucity of scientific literature exploring patient safety in EMS. Research is needed to improve our understanding of problem magnitude and threats to patient safety and to guide interventions.