Patient Safety Perceptions in Pediatric Out-of-Hospital Emergency Care: Children's Safety Initiative

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• 作者：Jeanne-Marie Guise ; MD ; MPH¹ ; ² ; ³ ; ⁴ ; ^{guisej@ohsu.edu" class="auth_mail" title="E-mail the corresponding author} ; Garth Meckler ; MD ; MSHS¹ ; ⁵ ; Kerth O'Brien ; PhD⁶ ; Merlin Curry ; MD⁷ ; Phil Engle ; BS⁸ ; Caitlin Dickinson ; MPH¹ ; Kathryn Dickinson ; MPH¹ ; Matthew Hansen ; MD ; MCR² ; William Lambert ; PhD⁴
• 关键词：EMS ; Emergency medical service ; EMT-B ; Emergency medical technician-basic ; EMT-I ; Emergency medical technician-intermediate ; EMT-P ; Emergency medical technician-paramedic
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：167
• 期：5
• 页码：1143-1148.e1
• 全文大小：527 K

文摘

To characterize emergency medical service (EMS) providers' perceptions of the factors that contribute to safety events and errors in the out-of-hospital emergency care of children.

Study design

We used a Delphi process to achieve consensus in a national sample of 753 emergency medicine physicians and EMS professionals. Convergence and stability were achieved in 3 rounds, and findings were reviewed and interpreted by a national expert panel.

Results

Forty-four (88%) states were represented, and 66% of participants were retained through all 3 rounds. From an initial set of 150 potential contributing factors derived from focus groups and literature, participants achieved consensus on the following leading contributors: airway management, heightened anxiety caring for children, lack of pediatric skill proficiency, lack of experience with pediatric equipment, and family members leading to delays or interference with care. Somewhat unexpectedly, medications and communication were low-ranking concerns. After thematic analysis, the overarching domains were ranked by their relative importance: (1) clinical assessment; (2) training; (3) clinical decision-making; (4) equipment; (5) medications; (6) scene characteristics; and (7) EMS cultural norms.

Conclusions

These findings raise considerations for quality improvement and suggest important roles for pediatricians and pediatric emergency physicians in training, medical oversight, and policy development.