A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar

dc.contributor.advisorStassen, Willem
dc.contributor.advisorHoward, Ian
dc.contributor.authorHeuer, Calvin
dc.date.accessioned2022-02-22T04:19:11Z
dc.date.available2022-02-22T04:19:11Z
dc.date.issued2021
dc.date.updated2022-02-16T06:12:30Z
dc.description.abstractIntroduction Adverse Events (AEs) in Helicopter Emergency Medical Services (HEMS) remains poorly reported, despite the potential for harm to occur. The Trigger Tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their Proximal Causes (PCs) in Qatar HEMS. Methods Using the Pittsburgh Adverse Event Tool (PittAETool) to identify AEs in HEMS, we retrospectively analyzed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for Triggers, AEs, and Harm per 100 patient encounters, plotted measures on Statistical Process Control (SPC) charts, and conducted a multivariate analysis to report harm associations. Results We identified 883 Triggers in 536 patients, with a rate of 1.1 Triggers per Patient Encounter, where 81.2% had Documentation Errors (n=436). An AE and Harm rate of 27.7% and 3.5% respectively was realized. The leading PC was Actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the Intervention and Medication triggers (n=16), where Deviation from Standard of Care was common (37.9%; n=11). Age and diagnosis adjusted odds was significant in the Patient Condition (6.50; 95% CI, 1.71-24.67; P= 0.01) and Interventional (11.85; 95% CI, 1.36-102.92; P= 0.03) trigger groupings, while age and diagnosis had no effect on Harm. Conclusion The TT methodology is a robust, reliable, and valid means of AE detection in the HEMS domain. Whilst an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and Documentation errors should also be addressed in future research.
dc.identifier.apacitationHeuer, C. (2021). <i>A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar</i>. (). ,Faculty of Health Sciences ,Division of Emergency Medicine. Retrieved from http://hdl.handle.net/11427/35806en_ZA
dc.identifier.chicagocitationHeuer, Calvin. <i>"A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar."</i> ., ,Faculty of Health Sciences ,Division of Emergency Medicine, 2021. http://hdl.handle.net/11427/35806en_ZA
dc.identifier.citationHeuer, C. 2021. A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar. . ,Faculty of Health Sciences ,Division of Emergency Medicine. http://hdl.handle.net/11427/35806en_ZA
dc.identifier.ris TY - Master Thesis AU - Heuer, Calvin AB - Introduction Adverse Events (AEs) in Helicopter Emergency Medical Services (HEMS) remains poorly reported, despite the potential for harm to occur. The Trigger Tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their Proximal Causes (PCs) in Qatar HEMS. Methods Using the Pittsburgh Adverse Event Tool (PittAETool) to identify AEs in HEMS, we retrospectively analyzed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for Triggers, AEs, and Harm per 100 patient encounters, plotted measures on Statistical Process Control (SPC) charts, and conducted a multivariate analysis to report harm associations. Results We identified 883 Triggers in 536 patients, with a rate of 1.1 Triggers per Patient Encounter, where 81.2% had Documentation Errors (n=436). An AE and Harm rate of 27.7% and 3.5% respectively was realized. The leading PC was Actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the Intervention and Medication triggers (n=16), where Deviation from Standard of Care was common (37.9%; n=11). Age and diagnosis adjusted odds was significant in the Patient Condition (6.50; 95% CI, 1.71-24.67; P= 0.01) and Interventional (11.85; 95% CI, 1.36-102.92; P= 0.03) trigger groupings, while age and diagnosis had no effect on Harm. Conclusion The TT methodology is a robust, reliable, and valid means of AE detection in the HEMS domain. Whilst an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and Documentation errors should also be addressed in future research. DA - 2021_ DB - OpenUCT DP - University of Cape Town KW - Emergency Medicine LK - https://open.uct.ac.za PY - 2021 T1 - A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar TI - A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar UR - http://hdl.handle.net/11427/35806 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/35806
dc.identifier.vancouvercitationHeuer C. A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar. []. ,Faculty of Health Sciences ,Division of Emergency Medicine, 2021 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/35806en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDivision of Emergency Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.subjectEmergency Medicine
dc.titleA Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPhil
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