Safety is the prerequisite element to quality care for emergency services relating to children. Safety events occurring during the emergency medical care outside the hospital are poorly understood and high quality epidemiologic data are lacking. Background: While quality and safety issues have been analyzed in the hospital setting, safety events have not been evaluated in emergency prehospital services. New technologies provide unprecedented opportunities to conduct epidemiologic and simulation studies.
Aims : These studies aim to 1) identify reliable and valid measures for safety events in the prehospital care of children, 2) understand the incidence and contributors to safety events in the prehospital care for children, 3) understand individual, team, and systems issues that lead to safety events during in situ simulation of children's emergencies, and 4) establish a national system for the anonymous reporting of safety events. Methods: We will begin by conducting focus groups with Emergency Medical Services personnel and Emergency Department providers to characterize the range of and contributors to safety events in the EMS care of children. In turn, an expert panel will review a random sample of cases thought to be at high risk for a safety event (e.g., resuscitation, seizures, lights and siren transport) to develop screening and evaluation tools. These tools will be used to screen 1 year of pediatric EMS transports in a metropolitan area to identify safety events. All screen-positive records will be reviewed by an expert panel using a structured tool to confirm the safety event and assess contributing factors and preventability. In a complimentary approach, patient simulations will be used to evaluate the process by which safety events occur. Finally, we will develop a web-based reporting system to capture a broad range of safety events across all EMS systems: some of these events may be rare or undetectable in electronic records. Significance: This series of studies will exploit new technologies -- electronic records, simulation, and web-based reporting -- to develop a comprehensive understanding of safety events relating to the prehospital care of children. Identification of the factors contributing to safety events will inform improvements in training and implementation of safeguards to assure pediatric safety and quality in emergency care.

Public Health Relevance

Safety events occurring in the emergency care of children during transports to the hospital have not been evaluated. This study will use expert panel reviews, analysis of electronic EMS data, and patient simulation to measure the numbers and types of safety events occurring in the prehospital care of children. Identification of the factors contributing to safety events will inform improvements in training and implementation of safeguards to assure pediatric safety and quality in emergency care.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD062478-02
Application #
8121589
Study Section
Special Emphasis Panel (ZRG1-PSE-H (51))
Program Officer
Haverkos, Lynne
Project Start
2010-08-10
Project End
2015-05-31
Budget Start
2011-06-01
Budget End
2012-05-31
Support Year
2
Fiscal Year
2011
Total Cost
$623,862
Indirect Cost
Name
Oregon Health and Science University
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
096997515
City
Portland
State
OR
Country
United States
Zip Code
97239
Hansen, Matt; Eriksson, Carl; Mah, Nathan et al. (2017) Accuracy of Prefilled ""Code Cart"" Epinephrine Syringes for Direct Administration of Small Doses. JAMA Pediatr 171:393-394
Guise, Jeanne-Marie; Hansen, Matthew; Lambert, William et al. (2017) The role of simulation in mixed-methods research: a framework & application to patient safety. BMC Health Serv Res 17:322
Hansen, Matt; Eriksson, Carl; Skarica, Barbara et al. (2017) Safety events in pediatric out-of-hospital cardiac arrest. Am J Emerg Med :
Guise, Jeanne-Marie; Hansen, Matthew; O'Brien, Kerth et al. (2017) Emergency medical services responders' perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study. BMJ Open 7:e014057
Hansen, Matthew; Meckler, Garth; O?Brien, Kerth et al. (2016) Pediatric Airway Management and Prehospital Patient Safety: Results of a National Delphi Survey by the Children's Safety Initiative-Emergency Medical Services for Children. Pediatr Emerg Care 32:603-7
Hansen, Matthew; Meckler, Garth; Lambert, William et al. (2016) Patient safety events in out-of-hospital paediatric airway management: a medical record review by the CSI-EMS. BMJ Open 6:e012259
Hansen, Matthew; Meckler, Garth; Lambert, William et al. (2016) Paramedic assessment and treatment of upper airway obstruction in pediatric patients: an exploratory analysis by the Children's Safety Initiative-Emergency Medical Services. Am J Emerg Med 34:599-601
Hansen, Matthew; O'Brien, Kerth; Meckler, Garth et al. (2016) Understanding the value of mixed methods research: the Children's Safety Initiative-Emergency Medical Services. Emerg Med J 33:489-94
Jones, David; Hansen, Matt; Van Otterloo, Josh et al. (2016) Emergency Medical Services Provider Pediatric Adverse Event Rate Varies by Call Origin Pediatric Emergency Care. Pediatr Emerg Care :
Burns, Beech; Hansen, Matthew L; Valenzuela, Stacy et al. (2016) Unnecessary Use of Red Lights and Sirens in Pediatric Transport. Prehosp Emerg Care 20:354-61

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