Hagiwara Magnus Andersson, Magnusson Carl, Herlitz Johan, Seffel Elin, Axelsson Christer, Munters Monica, Strömsöe Anneli, Nilsson Lena
Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30, Gothenburg, Sweden.
BMC Emerg Med. 2019 Jan 24;19(1):14. doi: 10.1186/s12873-019-0228-3.
Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care.
We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria.
The reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9-5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1-0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew.
There were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid.
在过去几十年中，院前急救护理发展迅速。这种护理是在复杂的环境中进行的，这使得院前护理在患者安全方面成为一项潜在的高风险活动。院前环境中的患者安全研究较少。本研究的目的是：1）调查院前护理中不良事件（AE）的发生率；2）调查导致院前护理中不良事件的因素。
我们采用回顾性研究设计，在瑞典的三个院前急救组织中，为期一年，每月随机抽取30份院前医疗记录筛查不良事件。共纳入1080份院前医疗记录。记录审查基于11项筛查标准。
审查人员在1080份（4.3%）院前医疗记录中的46份中识别出46起不良事件。在这46起不良事件中，43起被归类为可能造成伤害（AE1）（4.0，95%置信区间=2.9-5.4），3起被归类为已识别的伤害（AE2）（0.3，95%置信区间=0.1-0.9）。然而，在患有危及生命疾病（优先级1）的患者中，不良事件的风险更高（16.5%）。导致不良事件的最常见因素是偏离护理标准以及记录缺失、不完整或不清楚。不良事件的最常见原因是紧急医疗服务（EMS）人员的行动或不作为。
在瑞典的院前护理中，每100次救护车任务中有4.3起不良事件。大多数不良事件源于偏离护理标准和记录不完整。在EMS团队评估为患有危及生命疾病的患者中，不良事件的风险增加。大多数不良事件是可以避免的。
