Patient safety and patient assessment in pre-hospital care: a study protocol

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Abstract

Background

Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden.

Methods/Design

The study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with the final hospital assessment. Three different ambulance organisations are participating in the study. Every month, one rater in each organisation randomly collects 30 medical records for review. With guidance from the review instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of problematic reviews. The results will be analysed with descriptive statistics and logistic regression.

Discussion

The findings will make an important contribution to knowledge about patient safety issues in pre-hospital care.

Related collections

Most cited references 31

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Human Error

James Reason (1990)

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A new, evidence-based estimate of patient harms associated with hospital care.

John T. James (2013)

Based on 1984 data developed from reviews of medical records of patients treated in New York hospitals, the Institute of Medicine estimated that up to 98,000 Americans die each year from medical errors. The basis of this estimate is nearly 3 decades old; herein, an updated estimate is developed from modern studies published from 2008 to 2011. A literature review identified 4 limited studies that used primarily the Global Trigger Tool to flag specific evidence in medical records, such as medication stop orders or abnormal laboratory results, which point to an adverse event that may have harmed a patient. Ultimately, a physician must concur on the findings of an adverse event and then classify the severity of patient harm. Using a weighted average of the 4 studies, a lower limit of 210,000 deaths per year was associated with preventable harm in hospitals. Given limitations in the search capability of the Global Trigger Tool and the incompleteness of medical records on which the Tool depends, the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year. Serious harm seems to be 10- to 20-fold more common than lethal harm. The epidemic of patient harm in hospitals must be taken more seriously if it is to be curtailed. Fully engaging patients and their advocates during hospital care, systematically seeking the patients' voice in identifying harms, transparent accountability for harm, and intentional correction of root causes of harm will be necessary to accomplish this goal.

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Human error: models and management

Reason (2000)

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Author and article information

Contributors

Magnus Andersson Hagiwara: magnus.hagiwara@hb.se

Lena Nilsson: lena.nilsson@regionostergotland.se

Anneli Strömsöe: anneli.stromsoe@mdh.se

Christer Axelsson: christer.axelsson@hb.se

Anna Kängström: anna.kangstrom.@hb.se

Johan Herlitz: Johan.herlitz@hb.se

Journal

Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med

Journal ID (iso-abbrev): Scand J Trauma Resusc Emerg Med

Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1757-7241

Publication date (Electronic): 12 February 2016

Publication date PMC-release: 12 February 2016

Publication date Collection: 2016

Volume: 24

Electronic Location Identifier: 14

Affiliations

[ ]Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden

[ ]Department of Anaesthesiology and Intensive Care, Linköping University, SE-581 85 Linköping, Sweden

[ ]Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden

[ ]School of Health, Care and Social Welfare, Mälardalens högskola, Box 883, SE-721 23 Västerås, Sweden

Article

Publisher ID: 206

DOI: 10.1186/s13049-016-0206-7

PMC ID: 4751749

PubMed ID: 26868416

SO-VID: 44e9a4e2-bc0a-465b-b898-72a581ae99e9

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.