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Patient Safety in Emergency Medical Services: Executive Summary and Recommendations from the Niagara Summit

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Patient Safety in Emergency Medical Services: Executive Summary and Recommendations from the Niagara Summit ORIGINAL RESEARCH N RECHERCHE ORIGINALE EM Advances Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit Blair L. Bigham, MSc, ACPf*; Ellen Bull, BScN, MAEd3; Merideth Morrison, ACP4; Rob Burgess, ACP1; Janet Maher, PhD||; Steven C. Brooks, MD, MSc*"#; Laurie J. Morrison, MD, MSc*"on behalf of the Pan-Canadian Patient Safety in EMS Advisory Group ABSTRACT RE´SUME´ Emergency medical services (EMS) personnel care for Le person-nel des services me´ dicaux d’urgence (SMU) doit patients in challenging and dynamic environments that souvent intervenir dans des contextes difficiles et instables may contribute to an increased risk for adverse events. pouvant accroıˆtre les risques d’e´ve´ nements inde´ sirables. Or, However, little is known about the risks to patient safety in les risques pour la se´ curite´ des patients dans ce contexte the EMS setting. To address this knowledge gap, we sont me´ connus. Pour reme´ dier a` cette situation, nous avons conducted a systematic review of the literature, including effectue´ une analyse documentaire comple` te, y compris des nonrandomized, noncontrolled studies, conducted qualita- e´ tudes non randomise´ es et non controˆle´ es, re´ alise´ des tive interviews of key informants, and, with the assistance of entrevues qualitatives d’informateurs cle´ s et, avec l’assis- a pan-Canadian advisory board, hosted a 1-day summit of 52 tance d’un conseil consultatif pancanadien, organise´ une experts in the field of EMS patient safety. The intent of the table ronde d’une journe´e re´ unissant 52 experts dans le summit was to review available research, discuss the issues domaine de la se´ curite´ des patients et des SMU. Le but de affecting prehospital patient safety, and discuss interven- cette rencontre e´ tait d’examiner les recherches disponibles, tions that might improve the safety of the EMS industry. The de discuter des questions touchant la se´ curite´ des patients en primary objective was to define the strategic goals for milieu pre´ hospitalier et de discuter des interventions pour improving patient safety in EMS. Participants represented ame´ liorer leur se´ curite´ . Notre principale intention e´ tait de all geographic regions of Canada and included administra- de´ finir les objectifs strate´ giques pour ame´ liorer la se´ curite´ tors, educators, physicians, researchers, and patient safety des patients dans les SMU. Les participants repre´ sentaient experts. Data were collected through electronic voting and toutes les re´ gions ge´ ographiques du Canada et incluaient qualitative analysis of the discussions. The group reached des administrateurs, des e´ ducateurs, des me´ decins, des consensus on nine recommendations to increase awareness, chercheurs et des experts en se´ curite´ des patients. Les reduce adverse events, and suggest research and educa- donne´ es ont e´te´ recueillies a` l’aide d’un vote e´ lectronique et tional directions in EMS patient safety: increasing awareness d’analyses qualitatives des discussions. Le groupe d’experts of patient safety principles, improving adverse event report- est parvenu a` un consensus sur 9 recommandations pour ing through creating nonpunitive reporting systems, sup- accroıˆtre la sensibilisation, re´ duire les e´ve´ nements inde´ sir- porting paramedic clinical decision making through ables et proposer des orientations de recherche et d’appren- improved research and education, policy changes, using tissage relatives a`lase´ curite´ des patients dans les SMU : flexible algorithms, adopting patient safety strategies from prise de conscience croissante des principes de la se´ curite´ other disciplines, increasing funding for research in patient des patients, ame´ lioration de la de´ claration des e´ve´ nements safety, salary support for paramedic researchers, and access inde´ sirables par la cre´ ation de syste` mes de signalement non to graduate training in prehospital research. punitif, appui de la prise de de´ cision clinique par les From the *Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON; 3School of Community and Health Studies, Centennial College, Toronto, ON; 4Simcoe County Paramedic Services, Barrie, ON; 1Sunnybrook–Osler Centre for Prehospital Care, Toronto, ON; ||Applied Research and Innovation Centre, Centennial College, Toronto, ON; "Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON; and #Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON. Correspondence to: Blair Bigham, BSc MSc ACPf, Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital and University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8; [email protected]. This article has been peer reviewed. ß Canadian Association of Emergency PhysiciansCJEM 2011;13(1):13-18 DOI 10.2310/8000.2011.100232 CJEM N JCMU 2011;13(1) 13 Bigham et al parame´ dics par l’ame´ lioration de la recherche et de la formation postdoctorale en recherche relative aux soins formation, modifications des politiques, utilisation d’algor- pre´ hospitaliers. ithmes flexibles, adoption de strate´ gies de se´ curite´ des patients provenant d’autres disciplines, augmentation du Keywords: adverse events, emergency medical services, financement pour la recherche en se´ curite´ des patients, aide paramedicine, patient safety, safety culture salariale pour les chercheurs parame´ dicaux, et acce`s a` une Emergency medical services (EMS) personnel care for safety challenges in Canadian EMS. This document is patients in challenging and dynamic environments that an executive summary of that day’s dynamic, wide- may contribute to an increased risk for adverse events. ranging discussions. Our hope is that the consensus we However, little is known about the risks to patient present may serve to guide future research and policy safety in the EMS setting. To address this knowledge relating to prehospital patient safety. gap, the Canadian Patient Safety Institute (CPSI) partnered with the Emergency Medical Services Chiefs PARTICIPANTS of Canada (EMSCC) and the Calgary EMS Foundation to fund research examining patient safety The participants were selected by a pan-Canadian in the EMS setting. The phases of the research advisory committee and identified their current pri- involved a systematic review of the literature, qualita- mary role in EMS or a related field as patient safety tive interviews of key informants from Canada and experts (8%), EMS administrators (61%), physicians abroad, and a 1-day summit that brought together (16%), other health care professionals (5%), educators leaders in EMS and patient safety experts to discuss the (3%), or other (8%). None of the participants were successes, challenges, and future directions of the practicing paramedics (0%); however, many were creden- patient safety movement in Canadian prehospital care.1 tialed and previously active in the field. Two-thirds of The first Canadian Patient Safety in EMS Summit participants reported having . 20 years of experience was held June 1, 2009, in Niagara Falls, Ontario, and in their respective fields. Participants were not included 52 patient safety, EMS, and research experts, compensated or reimbursed for any costs associated 51 from across Canada and 1 from the United States. with the summit. The definition of patient safety employed by the World Health Organization (WHO) was used where ISSUES patient safety is defined as the ‘‘reduction of risk of unnecessary harm associated with healthcare to an The discussion was grounded on issues identified in a acceptable minimum.’’2 The term ‘‘acceptable mini- systematic review of the world’s literature on EMS mum’’ refers to the collective notions given current patient safety that included noncontrolled trials and knowledge, the resources available, and the context in qualitative studies. In addition, the participants which care was delivered weighed against the risk of reviewed the results of a qualitative study of key nontreatment or other treatment.1 Results from the informants who were interviewed to identify the systematic review and key informant interviews were central issues related to patient safety in EMS in the presented to the participants, who were then encour- United States and Canada.3 Summit discussants were aged to read, analyze, and discuss the results and share asked to rate the importance and feasibility of the their own beliefs in both small groups and collectively. themes that emerged from the systematic review and Information that emerged through discussion was qualitative research on 5-point Likert scales (anchored captured using both anonymous electronic responses by 1 5 not important, 5 5 very important or 1 5 not and note taking by the research team, which was feasible to implement, 5 5 very feasible to implement subsequently thematically analyzed. Three breakout as appropriate) using hand-held technology (Table 1). sessions chaired by an external professional facilitator Scores of 4 and 5 were combined to identify issues of fostered discussion on reactions to the research high importance or feasibility. findings and led to the identification of innovative The most prominent patient safety issue discussed opportunities, existing programs and tools applicable was clinical judgment and decision making, rated as to EMS patient safety, and next steps to address patient highly important by 95% of attendees. There was a 14 2011;13(1) CJEM N
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