Addressing the challenges of
patient safety in emergency care
Of all the facets of the health care system, there are few things as chaotic and complex as emergency care.
Not only do emergency workers effort to manage busy emergency departments filled of frantic patients with a wide variety and severity of ailments, they’re thrown into some of the most challenging care settings imaginable, from the devastating and emotionally-charged scene of an accident to the cramped confines of an ambulance speeding towards the hospital.
EMS personnel often work in small, poorly lit spaces in environments that are chaotic, unfriendly and challenging for emergent or urgent healthcare interventions. Unlike a hospital, emergency scenes are often loud, cluttered and unfamiliar places to pre-hospital care providers. In addition to these challenging environmental factors, emotional stressors are often heightened by the presence of panicked family members, curious bystanders and a lack of human and medical resources. These physical and emotional stressors are further compounded by the time-sensitive nature of EMS care.
The arena in which EMS providers work is rich with opportunities for patient safety incidents, attributed to both provider and system error. In fact, a retrospective chart review of 15,000 cases revealed that the emergency department was the prevalent location in the hospital for a patient safety incident to occur. Several factors can affect patient safety in EMS, and rarely does any one factor act alone to create a patient safety incident. These factors may be human, relying on people to either commit or omit certain functions, or systemic, depending on procedures, administrative controls, engineering and design.
In 2010, the Canadian Patient Safety Institute (CPSI), in partnership with the EMS Chiefs of Canada (EMSCC) and the Calgary EMS Foundation, released a research paper titled, Patient Safety in Emergency Medical Services: Advancing and Aligning the Culture of Patient Safety in EMS. This groundbreaking and extensive research was the first of its kind in the world and brought together EMS and patient safety leaders from around the world to discuss the successes, the challenges and the future directions of the patient safety movement in emergency care.
The report finds that patient safety in the EMS setting has been poorly studied; there is a paucity of evidence, and very few experimental trials of interventions designed to make EMS safer.
Experts believe that collaboration across Canada is required to better define and understand patient safety incidents in emergency settings. Fortunately, many across Canada are working to improve patient safety in emergency care through a variety of interventions, including a pair of projects from Alberta Health Services.
For the past year, a team of EMS professionals have been working to build a unified response plan for air and ground that will articulate the roles and responsibilities and outline standard operating procedures for EMS workers in the province of Alberta. Drawing from emergency services plans from across the country and gathering input from stakeholders, they’ve been able to identify best practices that work for Alberta’s healthcare system and one that will offer a coordinated response among emergency services workers and best possible service to the general public.
By implementing a business franchise model for emergency services in Alberta and improving the quality, efficiency and effectiveness of emergency services, patient safety will also improve.
Another intervention implemented in emergency settings by Alberta Health Services is a protocol for haemorrhage control. Uncontrolled haemorrhaging is a potentially life threatening condition that can lead to increased morbidity and mortality. Simple and rapid interventions, combined with rapid transport to definitive care, can be potentially lifesaving.
These interventions include pressure applied to the wound by direct pressure or pressure dressings, tourniquets when pressure fails to control the haemorrhage on an extremity injury, and pelvic binding of the unstable pelvis.
With this type of dedication paid to patient safety and quality improvement in emergency settings, through research, studies, frontline interventions and systemic changes, we are able to provide patients with the type of care they deserve to receive from our healthcare system, whether they’re accessing acute care, or waiting for emergency care in their time of need.