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Introduction of a Prehospital Critical Incident Monitoring System—Final Results

Published online by Cambridge University Press:  28 June 2012

Julian Stella ,
Bruce Bartley  and
Paul Jennings
Julian Stella*
Affiliation:
Emergency Medicine Specialist, Geelong HospitalEmergency Department, Barwon Health, Victoria, Australia
Bruce Bartley
Affiliation:
Emergency Medicine Specialist, Geelong HospitalEmergency Department, Barwon Health, Victoria, Australia
Paul Jennings
Affiliation:
Senior Operations Officer, Rural Ambulance Victoria, Victoria, Australia
*
Geelong Hospital, Emergency Department, Ryrie St Geelong 3220, Victoria, Australia E-mail: julianst@barwonhealth.org.au
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Abstract

Background:

Incident monitoring has been shown to improve patient care and has been adopted widely in the hospital care setting. There are limited data on incident monitoring in the prehospital setting.

Hypothesis:

A high-yield, systems-oriented, incident monitoring process can be implemented successfully in a prehospital setting.

Methods:

This prospective, descriptive study outlines the implementation of an incident monitoring process in a regional prehospital setting. Both trauma care and non-trauma care were monitored by a system of anonymous reporting and chart review with debriefing for trauma cases that met major trauma criteria. A committee reviewed all identified cases and coded and logged all incidents and provider recommendations.

Results:

There were 454 incidents identified from 230 cases (mean = 2.0; 95% CI 1.8−2.1 per case). Anonymous reporting resulted in the identification of 113 incidents from 69 cases (1.6l per case 95% CI = 1.4−1.9 per case) Major trauma cases generated 266 incidents from 134 cases (mean = 2.0; 95% CI = 1.8−2.2 per case), and there were 74 incidents from 26 combined cases (mean = 2.9; 95% CI = 2.2−3.5 per case). One incident was uncategorized. There were 315 (69.4%) incidents categorized as management problems and 123 (27.1%) were system problems. Prolonged scene time was the most common incident in both management and system categories; 56 (17.8%) and 18 (14.6%) respectively. Mitigating circumstances were found in 111 (24.4%) incidents. The most common incident-related patient outcome was none/near miss (127 (28%)). Incident monitoring most commonly led to generalized feedback (105 (23.1%)) or specific trend analysis (140 (30.8%)). Reports to higher or external bodies occurred in 18 incidents (4.0%).

Conclusions:

The project has been implemented successfully in a regional prehospital settling. The methodology, utilizing a number of incident detection techniques, results in a high yield of incidents over a broad range of error types. The large proportion of “near miss” type incidents allows for incident assessment without demonstrable patient harm. Many incidents were mitigated and the majority represented management-type issues.

Keywords

ambulancemedical errorquality assurancerisk managementtrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 6 , December 2010 , pp. 515 - 520
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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