Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
Clinical Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar.
BMJ Open Qual. 2023 Nov;12(4). doi: 10.1136/bmjoq-2023-002263.
Adverse events (AEs) in helicopter emergency medical services (HEMS) remain poorly reported, despite the potential for harm to occur. The trigger tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their proximal causes (PCs) in Qatar HEMS.
Using the Pittsburgh Adverse Event Tool to identify AEs in HEMS, we retrospectively analysed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for triggers, AEs and harm per 100 patient encounters, plotted measures on statistical process control charts, and conducted a multivariate analysis to report harm associations.
We identified 883 triggers in 536 patients, with a rate of 1.1 triggers per patient encounter, where 81.2% had documentation errors (n=436). An AE and harm rate of 27.7% and 3.5%, respectively, was realised. The leading PC was actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the intervention and medication triggers (n=16), where deviation from standard of care was common (37.9%; n=11). Age and diagnosis-adjusted odds were significant in the patient condition (6.50; 95% CI 1.71 to 24.67; p=0.01) and interventional (11.85; 95% CI 1.36 to 102.92; p=0.03) trigger groupings, while age and diagnosis had no effect on harm.
The TT methodology is a robust, reliable and valid means of AE detection in the HEMS domain. While an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and documentation errors should also be addressed in future research.
尽管直升机紧急医疗服务（HEMS）中可能会发生伤害，但不良事件（AE）的报告仍不完善。触发工具（TT）代表了一种用于医疗保健中 AE 检测的新方法。本研究的目的是回顾性描述卡塔尔 HEMS 中 AE 的频率及其近端原因（PC）。
使用匹兹堡不良事件工具来识别 HEMS 中的 AE，我们回顾性地分析了现有 AE TT 数据库中的 804 份记录（21 个月的时间段）。我们计算了每 100 次患者就诊的触发因素、AE 和伤害的发生率，将措施绘制在统计过程控制图上，并进行了多变量分析以报告伤害关联。
我们在 536 名患者中发现了 883 个触发因素，每个患者就诊的触发因素率为 1.1，其中 81.2%（n=436）存在文件记录错误。AE 和伤害发生率分别为 27.7%和 3.5%。主要的 PC 是 HEMS 机组人员的行动（81.6%；n=182）。大多数伤害（57.1%）源自干预和药物触发因素（n=16），其中偏离标准护理的情况很常见（37.9%；n=11）。年龄和诊断调整后的优势在患者病情（6.50；95%置信区间 1.71 至 24.67；p=0.01）和干预（11.85；95%置信区间 1.36 至 102.92；p=0.03）触发因素分组中具有统计学意义，而年龄和诊断对伤害没有影响。
TT 方法学是一种在 HEMS 领域中检测 AE 的强大、可靠和有效的方法。虽然 AE 发生率为 27.7%很高，但需要进一步研究来了解院前临床决策和偏离指南的原因。此外，未来的研究还应解决针对减少 AE 和文件记录错误的重点质量改进计划。
