Communication errors are a source of preventable medical errors. In high-risk health care settings, identifying the source and addressing root causes can reduce error and improve patient safety. While air medical transport is a high-risk setting, its sources and rates of error have been investigated only within the last several years.
This investigation examined the rate and types of communication errors during call booking of interfacility air medical transports. The primary objective was to determine the incidence and type of errors when the initial requests for transfer took place between the sending facility and transport medicine communication center. The secondary objective was to identify potential underlying causes of these errors.
Requests for urgent and emergent interfacility air medical transfers were examined prospectively during a consecutive two-week period. As the first step in call booking, sending facility staff speak directly to communication center staff and are asked for administrative, demographic, and medical details to determine patient acuity and call priority. After this information was captured, investigators contacted the sending facility to verify the information and identify any communication errors. Errors were classified as major (potentially impacting care) or minor (unlikely to impact care) and as errors of omission or commission. Common error types were presented to a management focus group to identify potential contributing causes for these errors.
One hundred twelve calls were randomly selected during the study period, with 98 meeting study criteria. Of those, 41 (42%) calls contained a total of 65 errors. Eleven were classified as major, including five errors of omission and six errors of commission. The most common major errors were recording "no drug allergies" when a drug allergy was present (n = 4), incorrect diagnosis (n = 2), and failure to record that patients were intubated or required mechanical ventilation (n = 2 each). There were 54 minor errors, including 41 omission errors and 13 commission errors. Nearly half the errors were attributed to procedures and software. No identified error resulted in patient harm or an adverse outcome.
Communication-based errors are common in the initial phases of call booking in air medical transport. Human and process-driven errors contribute equally to these errors.
[Did the distribution of trauma treatment by general practitioners and emergency departments in the county of Ringkøbing change after the introduction of the on-call coverage for general practitioners?].
The aim of the study was to investigate the changes in minor trauma treatment structure after a reduction in the number of general practitioners on call in a county, where minor trauma treatment is supposed to be carried out by general practitioners and only major trauma is supposed to be treated at the hospital Accident and Emergency Department. The design was a cross-sectional analysis of trauma treatment in Ringkøbing County before and after the reduction in the number of general practitioners on call. Over a four week period before and after the reduction in the number of general practitioners on call all trauma treatment at the Accident and Emergency Departments was registered together with trauma treatment by general practitioners. Furthermore a questionnaire was given before and after the reduction to a sample of the population regarding the population's behaviour and attitude towards minor trauma. Analysis showed that there was a minor reduction in the total number of trauma treatments after the reduction in the number of general practitioners on call was made. The percentage of patients that were treated at the Accident and Emergency Departments at hospital directly without being referred from general practitioners was reduced from 30% to 21%. The population's behaviour and attitude towards minor trauma was unchanged.
OBJECTIVE: To evaluate the efficiency (sensitivity, specificity, positive predictive value, overtriage, and undertriage) of activation of the trauma team in a Norwegian trauma referral centre. DESIGN: A cohort study with univariate and multivariate analysis. SETTING: A primary trauma hospital and trauma referral centre, Norway. SUBJECTS: 3391 injured patients admitted during a 12 months period, starting January 15th, 1996. MAIN OUTCOME MEASURES: Activation of the trauma team for severely injured patients and factors associated with correct activation. RESULTS: Of the 3383 injured patients admitted, 283 (8%) were classified as severely injured. Of 507 activations of the trauma team, 240 (47%) were for severely injured patients (sensitivity 85%, undertriage 15%, specificity 91%, overtriage 9%, positive predictive value 0.47). The system of activation was significantly more efficient for patients admitted by anaesthetist-manned ambulances than by ordinary ground ambulances (sensitivity 94% compared with 83%, corresponding positive predictive value 0.55 and 0.33, p
Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers' work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work?
The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n?=?19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis.
Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) "Core technologies" and 2) "Environmental issues" . The theme "Core technologies" included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme "Environmental issues" included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service.
At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker's ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system.
Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg, Sweden.
OBJECTIVE: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive. PATIENTS: All patients hospitalised alive in the community of Göteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included. METHODS: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded. Patients were divided into two groups (the first and second 10 year periods). SETTING: Community of Göteborg, Sweden. RESULTS: 5505 patients suffered from cardiac arrest during the time of the survey. Among them 1310 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% CI 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% CI 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% CI 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% CI 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% CI 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% CI 0.47 to 0.88); atropine required in the emergency department (OR 0.35, 95% CI 0.16 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0.59, 95% CI 0.43 to 0.81). CONCLUSION: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine in the emergency department, and chronic treatment with diuretics before cardiac arrest.
Dispatching centres were fused into one of the 112 entity, which caused concerns regarding whether the medical calls could be processed effectively also in the new centre. We evaluated the effects of the reform on key performance criteria in medical calls.
This observational study in the Helsinki Dispatching Centre consisted of two periods: Period I 2 years before the reform and Period II 2 years after. The main outcome measures were answering and call processing times, accuracy of risk assessment and appropriate use of ambulances.
In Period I (n=574,276), 92.2% of all incoming phone calls were answered within 10 s and in Period II (n=758,022) 82.8% (P5 min and in Period II 29.8%, 36.1% and 34.1% (P
Previous studies from outdoor music festivals have recommended medical service facilities at first-aid stations. The Cutty Sark Tallships Race was a large outdoor event that took place over four days in Esbjerg harbour with about 500,000 participants and spectators. A total of 68 patients were treated, 28 in the first-aid station at the harbour and 40 at the nearby located hospital. The disease and injuries presented were not severe. The orthopaedic casualties dominated (82%), wounds, contusions and fractures being the most common ones. Only seven casualties were related to alcohol abuse. No casualties were related to drug abuse. The economic expense was estimated to DKK 14,676. Thus, at outdoor mass gatherings of a nature like the Cutty Sark Tallships Race, located near a hospital, first-aid stations are not necessary.
Limited data are available on casualty clinic facilities and localisation, inter-municipal co-operation and routines for out-of-hours services in the 433 Norwegian municipalities. The National centre for emergency primary health care collected data on these issues from October 2005 until February 2006.
Questionnaires concerning organisation of the out-of-hours services, casualty clinic facilities, locations and routines were sent to every Norwegian municipality.
282 of the 433 municipalities are in charge of out-of-hours services in 262 districts in the evenings and 230 districts during nights and weekends. There is inter-municipal cooperation in 100 of the districts. Most out-of-hours services are located in one casualty clinic in the host municipality and have the same locations as GP surgeries and laboratories. Most clinics offered the same services, but some routines were different. About half of the casualty clinics had a system for training of doctors and other health personnel. Half of the doctors on duty were available on the emergency communications system (radio). User assessments were collected, telephone calls documented and discrepancies reported to a varying degree, and medical histories were not consistently sent to regular GPs.
Inter-municipal co-operations are most common in areas with a high population density, i.e. in southern and eastern parts of Norway. Varying routines in out-of-hours service districts indicate that several municipalities do not fulfil all the obligations in regulations from the Ministry of health and care services in Norway.
