O'connor Paul, O'malley Roisin, Oglesby Anne-Marie, Lambe Kathryn, Lydon Sinéad
Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland.
Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland.
Int J Qual Health Care. 2021 Feb 5;33(1). doi: 10.1093/intqhc/mzab013.
Prehospital care is potentially hazardous with the possibility for patients to experience an adverse event. However, as compared to secondary care, little is known about how patient safety is managed in prehospital care settings.
The objectives of this systematic review were to identify and classify the methods of measuring and monitoring patient safety that have been used in prehospital care using the five dimensions of the Measuring and Monitoring Safety (MMS) framework and use this classification to identify where there are safety 'blind spots' and make recommendations for how these deficits could be addressed.
Searches were conducted in January 2020, with no limit on publication year, using Medline, PsycInfo, CINAHL, Web of Science and Academic Search. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies concerned with measuring and monitoring safety in prehospital care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool (the Quality Assessment Tool for Studies with Diverse Designs).
A total of 5301 studies were screened, with 52 included in the review. A total of 73% (38/52) of the studies assessed past harm, 25% (13/52) the reliability of safety critical processes, 1.9% (1/52) sensitivity to operations, 38.5% (20/52) anticipation and preparedness and 5.8% (3/52) integration and learning. A total of 67 methods for measuring and monitoring safety were used across the included studies. Of these methods, 38.8% (26/67) were surveys, 29.9% (20/67) were patient records reviews, 14.9% (10/67) were incident reporting systems, 11.9% (8/67) were interviews or focus groups and 4.5% (3/67) were checklists.
There is no single method of measuring and monitoring safety in prehospital care. Arguably, most safety monitoring systems have evolved, rather than been designed. This leads to safety blind spots in which information is lacking, as well as to redundancy and duplication of effort. It is suggested that the findings from this systematic review, informed by the MMS framework, can provide a structure for critically thinking about how safety is being measured and monitored in prehospital care. This will support the design of a safety surveillance system that provides a comprehensive understanding of what is being done well, where improvements should be made and whether safety interventions have had the desired effect.
院前护理具有潜在危险性，患者有可能经历不良事件。然而，与二级护理相比，人们对院前护理环境中如何管理患者安全知之甚少。
本系统评价的目的是使用测量与监测安全（MMS）框架的五个维度来识别和分类院前护理中用于测量和监测患者安全的方法，并利用这一分类来确定安全“盲点”所在，并就如何弥补这些不足提出建议。
于2020年1月进行检索，对出版年份无限制，使用医学数据库（Medline）、心理学文摘数据库（PsycInfo）、护理学与健康领域数据库（CINAHL）、科学引文索引数据库（Web of Science）和学术搜索数据库（Academic Search）。还筛选了纳入研究的参考文献列表和现有的相关综述。纳入了有关院前护理中测量和监测安全的英文同行评审研究。两名研究人员独立从研究中提取数据，并应用了质量评估工具（针对不同设计研究的质量评估工具）。
共筛选了5301项研究，其中52项纳入综述。共有73%（38/52）的研究评估了既往伤害，25%（13/52）评估了安全关键流程的可靠性，1.9%（1/52）评估了对操作的敏感性，38.5%（20/52）评估了预期和准备情况，5.8%（3/52）评估了整合与学习情况。纳入研究共使用了67种测量和监测安全的方法。在这些方法中，38.8%（26/67）是调查，29.9%（20/67）是患者记录审查，14.9%（10/67）是事件报告系统，11.9%（8/67）是访谈或焦点小组，4.5%（3/67）是检查表。
院前护理中没有单一的测量和监测安全的方法。可以说，大多数安全监测系统是演变而来的，而非设计出来的。这导致了信息缺失的安全盲点，以及工作的冗余和重复。建议本系统评价的结果，在MMS框架的指导下，可为批判性思考院前护理中如何测量和监测安全提供一个结构。这将有助于设计一个安全监测系统，全面了解哪些方面做得好、哪些方面需要改进以及安全干预措施是否产生了预期效果。
