Factors influencing witnesses' perception of patient safety during pre-hospital health care from emergency medical services: A multi-center cross-sectional study.

AIM: To determine the factors related with the perception of feeling safe during pre-hospital emergency care. METHODS: A multi-centred, cross-sectional study. Data collection from April 2021 to March 2022, in the Centro de Emergencias Sanitarias 061 (Andalusia, Spain). INCLUSION CRITERIA: witnesses of health care by emergency medical services. EXCLUSION CRITERIA: minors, or communication barriers. OUTCOME VARIABLE: Witness Perceived Safety Scale ESPT10. The variables studied were related with sociodemographic data, the request for health care, the patient, the hospital transfer and patient safety incidents. A multivariate linear regression model was constructed for the dependent variable. The study followed STROBE statement. RESULTS: Responses were obtained from 1400 witnesses. The linear regression model showed that the score on the scale increased as the witnesses felt more satisfied (B = 1.302; p < 0.001). On the contrary, the score was lower when the witness reported a patient safety incident (B = -2.856; p < 0.001 and B = -3.166; p < 0.001), or when the assistance took place in a public space (B = -0.722; p = 0.017). CONCLUSIONS: The level of satisfaction, the occurrence of a patient safety incident, and the place of health care are related factors with the perception of the witnesses. The Witness Perceived Safety Scale ESPT10 could be considered a valid and useful patient safety indicator.

Factores relacionados con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias: estudio transversal multicéntrico / Factors related to patients’ perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study

Objetivos: Conocer los factores que se relacionan con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias. Método: Estudio observacional descriptivo, transversal, multicéntrico, en los equipos de emergencias 061 de Andalucía. Se recogieron los datos desde abril 2021 hasta marzo 2022. Criterios de inclusión fueron pacientes asistidos y trasladados por equipos de emergencias, y los criterios de exclusión fueron menores de edad, deterioro cognitivo, alteración de consciencia, o barreras comunicativas. Se calculó un tamaño muestral mínimo de 644 sujetos. La variable resultado fue la puntuación de la Escala de Seguridad Percibida (ESP16). Se estudiaron variables sociodemográficas y relacionadas con la demanda asistencial, el paciente y el traslado. Además, se recogieron notificaciones de incidentes relacionados con la seguridad del paciente (IRSP). Se construyó un modelo de regresión lineal multivariable para la variable dependiente. Se siguieron las recomendaciones STROBE. Resultados: Se obtuvieron 1.756 respuestas. La puntuación media en la ESP16 fue 77,7 (DE 5,6), con mediana de 80. El modelo de regresión lineal mostró que el nivel de satisfacción (B = 2,799; p < 0,001), la notificación de error, caída, daño o lesión (B = –6,097; p < 0,001), la notificación de cualquier otro IRSP (B = –2,742; p < 0,001), la transferencia protocolizada (B = 2,538; p = 0,001), el tipo de recurso asistencial (B = 1,157; p < 0,001), un diagnóstico final cardiológico (B = 0,726; p = 0,014) y un nivel de dolor intenso (B = 1,195; p = 0,003) influían en la escala ESP16. Conclusiones: La percepción de seguridad del paciente es muy alta, y está condicionada por el nivel de satisfacción, la notificación de IRSP, la transferencia protocolizada, el recurso asistencial, el diagnóstico final y el nivel de dolor. (AU)

Aim: To identify factors related to patients’ feeling of safety during prehospital emergencies. Methods: Descriptive, multicenter cross-sectional study in the context of “061” emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports.Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed. Results: We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The b coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P < .001) for satisfaction; –6.097 (P < .001) for incident reports of errors, falls, harm, or injury; –2.742 (P < .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P < .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity. Conclusions: Patients’ perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level. (AU)

Factors related to patients' perception of feeling safe in pre-hospital emergencies: a multicenter cross-sectional study. / Factores relacionados con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias: estudio transversal multicéntrico.

OBJECTIVES: To identify factors related to patients' feeling of safety during prehospital emergencies. MATERIAL AND METHODS: Descriptive, multicenter cross-sectional study in the context of "061" emergency response services of Andalusia, Spain. Data were collected from April 2021 to March 2022. Patients attended and transported by emergency responders were eligible for inclusion. Patients were excluded if they were minors or in an altered state of consciousness, or had cognitive impairment or any barrier to communication. We calculated that a minimum sample size of 644 patients would be required. The outcome variable was the score on a 16-item scale of patient-perceived safety (ESP16, as abbreviated in Spanish). Sociodemographic, emergency service response, patient, and hospital transfer variables were studied in relation to ESP16 score. We also collected patient safety incident reports. Multivariate linear regression was used to analyze associations between the independent variables and the dependent outcome variable. Guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were followed. RESULTS: We received 1756 responses. The mean (SD) ESP16 score was 77.7 (5.6); the median score was 80. The ßô€€ƒ coefficients derived from the linear regression model were as follows for the variables associated with the ESP16 score: 2.799 (P .001) for satisfaction; -6.097 (P .001) for incident reports of errors, falls, harm, or injury; -2.742 (P .001) for reports of any other incident during attendance; 2.538 (P = .001) for use of the transport protocol; 1.157 (P .001) for type of emergency transport used; 0.726 (P = .014) for a cardiology diagnosis; and 1.195 (P = .003) for pain intensity. CONCLUSION: Patients' perception of safety is very high, as reflected by level of satisfaction, incident reports, use of a transport protocol, means of transport used, diagnosis, and pain level.

OBJETIVO: Conocer los factores que se relacionan con la percepción de los pacientes de sentirse seguros en emergencias extrahospitalarias. METODO: Estudio observacional descriptivo, transversal, multicéntrico, en los equipos de emergencias 061 de Andalucía. Se recogieron los datos desde abril 2021 hasta marzo 2022. Criterios de inclusión fueron pacientes asistidos y trasladados por equipos de emergencias, y los criterios de exclusión fueron menores de edad, deterioro cognitivo, alteración de consciencia, o barreras comunicativas. Se calculó un tamaño muestral mínimo de 644 sujetos. La variable resultado fue la puntuación de la Escala de Seguridad Percibida (ESP16). Se estudiaron variables sociodemográficas y relacionadas con la demanda asistencial, el paciente y el traslado. Además, se recogieron notificaciones de incidentes relacionados con la seguridad del paciente (IRSP). Se construyó un modelo de regresión lineal multivariable para la variable dependiente. Se siguieron las recomendaciones STROBE. RESULTADOS: Se obtuvieron 1.756 respuestas. La puntuación media en la ESP16 fue 77,7 (DE 5,6), con mediana de 80. El modelo de regresión lineal mostró que el nivel de satisfacción (B = 2,799; p 0,001), la notificación de error, caída, daño o lesión (B = ­6,097; p 0,001), la notificación de cualquier otro IRSP (B = ­2,742; p 0,001), la transferencia protocolizada (B = 2,538; p = 0,001), el tipo de recurso asistencial (B = 1,157; p 0,001), un diagnóstico final cardiológico (B = 0,726; p = 0,014) y un nivel de dolor intenso (B = 1,195; p = 0,003) influían en la escala ESP16. CONCLUSIONES: La percepción de seguridad del paciente es muy alta, y está condicionada por el nivel de satisfacción, la notificación de IRSP, la transferencia protocolizada, el recurso asistencial, el diagnóstico final y el nivel de dolor.

Factors influencing the perception of feeling safe in pre-hospital emergency care: A mixed-methods systematic review.

AIMS: To systematically describe the factors influencing the perception of feeling safe among patients receiving pre-hospital emergency care. BACKGROUND: Patient safety is a top priority worldwide. Little is known about how patients perceive safety during emergency health care and what the related factors are. DESIGN: A mixed-methods systematic review. METHODS: Six databases were searched to December 2021. Inclusion criteria were as follows: studies with patients of any age, framed in pre-hospital emergency care settings, referring to patient safety, addressing the perception of safety, and with a quantitative or qualitative research design. Exclusion criteria were as follows: conference records, abstracts, supplements, letters, editorials and reviews. The quality of the evidence was assessed with the Joanna Briggs Institute (JBI) checklists. A convergent integrated approach was followed according to the JBI methodology. The protocol was registered on PROSPERO (CRD42022306337). PRISMA 2020 guidelines were followed in reporting this review. RESULTS: Among the 5223 records identified, the whole texts of 35 articles were reviewed. Ten studies were relevant to the research question. Seven followed a qualitative methodology, with interviews or focus group. Three involved a quantitative methodology, with questionnaires or validated measures. The 74 findings were organised into 11 categories and then grouped into four dimensions: 'receiving a satisfying response from healthcare professionals when I need it', 'EMS personnel's professional competence', 'the variable and unfamiliar settings of pre-hospital emergencies', and 'patients' personal characteristics'. CONCLUSIONS: The perception of safety is influenced by many factors, which can be grouped into four independent dimensions. Quantitative and qualitative studies can provide us with complementary findings. RELEVANCE TO CLINICAL PRACTICE: Awareness of these factors enables us to act upon them. When patients feel safe their health outcomes improve, their anxiety decreases and they collaborate more actively. NO PATIENT OR PUBLIC CONTRIBUTION: Patients and caregivers shared their experiences in the articles included.

Development and Validation of a Safety Scale Perceived by the Witness of Prehospital Emergency Care.

OBJECTIVE: The aim of the study was to design and validate a new tool to measure the security perceived by witnesses of patient care and hospital transfers, after requesting urgent assistance via the "061" phone number. METHODS: This is a descriptive observational, cross-sectional, design, and validation study of a scale conducted by telephone interview. Witnesses of urgent assistance and transfers by prehospital emergency medical services in the province of Cadiz, in the south of Spain, were the subjects of study. A questionnaire was designed after focus groups with patients, witnesses, and professionals. It consisted of 10 items, with Likert-type answers, and a range of 0 to 50 points. In addition to basic criteria (frequency of endorsement and ability to discriminate between groups), their validity (content and construct) and reliability (stability and homogeneity) were evaluated. Stability was evaluated by test-retest and homogeneity by means of two properties: internal consistency of items (corrected item-scale correlation coefficient) and internal consistency of the scale (Cronbach α coefficient). RESULTS: A total of 849 questionnaires were obtained, with scores between 0 and 50 points, with an average of 47.31 (median of 50). The exploratory factor analysis detected a component that explained 61.1% of the total variance. The intraclass correlation coefficient was 0.933 with 95% confidence interval between 0.900 and 0.954. The corrected item-scale correlation coefficient was greater than 0.596, and the Cronbach α coefficient was 0.927 (95% confidence interval, 0.919-0.934). CONCLUSIONS: The ESPT10 Witness Perceived Safety Scale is valid and reliable for quantifying the safety perception of witnesses of emergency assistance and transfers.

Esterilidad de sueros purgados. Antes de su uso en urgencias y emergencias extrahospitalarias / Sterility in drained serums; before their use in emergency wards and in non-hospital emergency use

Se detallan las características de esterilidad de los sueros purgados y ubicados dentro de una UVI-móvil, y se determina cuánto tiempo pueden mantener las condiciones óptimas para su uso, mediante un ensayo clínico controlado y aleatorizado, triple ciego, donde las unidades de estudio fueron sueros preparados con sistema de infusión y llave de tres vías. Se recogieron datos durante un periodo de estudio de 12 meses. Se diseñaron seis grupos de intervención en función del tiempo de exposición y su ubicación. Tamaño muestral de 672 unidades. Se realizaron 12 cultivos microbiológicos a cada una, para bacterias y hongos, tanto aerobios como anaerobios. Se contrastó hipótesis con un modelo de regresión logística multivariante para la variable "esterilidad". Se consideró significativo un valor de p < 0,05. Se obtuvieron resultados de 669 sueros (98,82%). Existió colonización en 1,7% de los 8.028 cultivos realizados, encontrando más de 10 UFC/ml sólo en dos casos. Esta colonización correspondió a 103 sueros que se clasificaron como "no estériles". Para la esterilidad, el modelo de regresión logística no mostró asociación significativa con los diferentes grupos de intervención, controlando mediante dos variables posiblemente confusoras. No se encontraron evidencias de que el suero recién purgado fuera diferente, desde el punto de vista de esterilidad, a los expuestos durante 24, 48 o 72 horas pero, a igualdad de grupos, las incidencias de los sueros triplicaban el riesgo de colonización. Se concluyó que podríamos utilizar sueros preparados con antelación, garantizando una esterilidad similar a los recién purgados(AU)

The authors detail the characteristics for the sterility of drained serums placed in a mobile emergency service unit and they determine how much time they can maintain optimum conditions for the use of these serums by means of a controlled, random, triple blind clinical test in which the units studied were serums prepared by an infusion system and a three-way valve. Data were gathered during a 12 month study period. The authors designed six operating groups based on their exposure time and where they were kept. These samples totaled 672 units. The authors carried out 12 microbiological cultural analyses for each unit; these analyses were tested for bacteria and fungi, both aerobic and anaerobic. The authors contrasted their hypothesis with a multivariable logistic regression model used as the variable for sterility. A value of p < 0.05 was considered to be significant. Results were obtained on 669 serums, 98.82% of samples. Colonization was found in 1.7% of the 8028 cultures analyzed; in only 2 cases was there a register greater than 10 UFC/ml. This colonization corresponded to 103 serums which were then classified as non-sterile. For sterility, the logistic regression model did not show any significant association with the various operating groups, which were controlled by means of two possible variable methods. The authors did not find evidence that recently drained serums were different, from the point of view of sterility, than the serums exposed during 24, 48 or 72 hours but, as well as for the groups, the incidences of these serums tripled the risk of colonization. The authors concluded they could use serums prepared previously and these serums sterility were guaranteed to the same degree as recently drained serums(AU)