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David Jones1, Matt Hansen1, Josh Van Otterloo2
1From the Departments of Emergency Medicine.
Insights
Pediatric emergency medical services transports from clinics or scenes have higher rates of adverse events than hospital transports. Severe adverse events were also more frequent from non-hospital origins, indicating patient safety concerns.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality and Safety
- Emergency Medical Services Research
Background:
- Emergency medical services (EMS) providers transport pediatric patients from diverse locations, including scenes, clinics, and hospitals.
- The origin of transport may influence the rate and severity of adverse events during pediatric critical care.
- Understanding these differences is crucial for improving patient safety in prehospital settings.
Purpose of the Study:
- To investigate the relationship between the origin of pediatric emergency medical services transports and the occurrence and severity of adverse events.
- To test the hypothesis that transports from less medically stabilizing origins are associated with higher adverse event rates and severity.
Main Methods:
- A retrospective review of all critical pediatric emergency medical services transports in an urban Oregon county in 2011.
- Standardized abstraction of records to identify UNSEMs (unintended injury, near miss, suboptimal action, error, management complication).
- Logistic regression analysis comparing UNSEM rates and severity based on transport origin (hospital, clinic, scene).
Main Results:
- Of 490 transports, 59 were from hospitals, 48 from clinics, and 384 from scenes.
- UNSEMs occurred in 40.7% of hospital transports, 68.8% of clinic transports, and 68.5% of scene transports.
- Severe UNSEMs were reported in 0% of hospital transports, 25.0% of clinic transports, and 16.9% of scene transports, with significantly lower odds from hospitals.
Conclusions:
- Pediatric emergency medical services care involving transports from clinics or scenes are associated with a higher likelihood of UNSEMs compared to hospital origins.
- Transports originating from hospitals demonstrate a lower incidence of both overall and severe adverse events.
- These findings highlight the importance of considering transport origin in pediatric emergency care quality improvement initiatives.
Objective:
Emergency medical services providers may be called to a variety of sites to transport pediatric patients, whether it be a scene call for initial evaluation and care, a clinic for transportation of a patient who has been assessed by medical providers, or a hospital where assessment and stabilization have already begun. We hypothesize that there may be a direct relationship between adverse event rates and adverse event severity in transports from less medically stabilizing origins.
Methods:
Emergency medical services records of all critical pediatric transports in an urban Oregon county in 2011 were reviewed and abstracted using a standardized tool. From this, UNSEMs (unintended injury, near miss, suboptimal action, error, management complication) were determined, and the potential severity of the issue was assessed. Then, UNSEMs were compared with the origin of transport using logistic regression.
Results:
Four hundred ninety records were abstracted: 59 hospital transports, 48 clinic transports, and 384 scene transports. Furthermore, UNSEMs were noted in 24 hospital transports (40.7%), 33 clinic transports (68.8%), and 263 scene transports (68.5%). Severe UNSEMs were reported on 0 hospital transports (0.0%), 12 clinic transports (25.0%), and 65 scene transports (16.9%). The odds ratio of UNSEM occurrence from a hospital compared with nonmedical scenes was 0.35 (95% confidence interval, 0.20-0.60), and the odds ratio of a severe UNSEM from a hospital compared with nonmedical scenes was 0.09 (95% confidence interval, 0.01-0.63).
Conclusions:
In conclusion, UNSEMs involving the emergency medical services care of children are more likely to occur when transport originates from a clinic or scene compared with a hospital.
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