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Adaption of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care of children
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden. (PreHospen)
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden. (PreHospen)
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)ORCID iD: 0000-0001-6505-9132
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)
2024 (English)In: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 24, article id 213Article in journal (Refereed) Published
Abstract [en]

Background

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers.

Methods

The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

Results

MethodsThe adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers.

Conclusion

This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods. 

Place, publisher, year, edition, pages
2024. Vol. 24, article id 213
Keywords [en]
Emergency medical services, Ambulance, Patient safety, Trigger tool, Children, Harmful incidents, Adverse events
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-32808DOI: 10.1186/s12873-024-01125-4OAI: oai:DiVA.org:hb-32808DiVA, id: diva2:1913768
Available from: 2024-11-15 Created: 2024-11-15 Last updated: 2024-11-27Bibliographically approved

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Packendorff, NiclasAxelsson, ChristerAndersson Hagiwara, Magnus

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