The issue of patient safety has garnered much attention in the past few decades, for a good reason. Beginning as early as 1999, important articles such as “To err is human,” from the Institute of Medicine, have cast a spotlight on just how dangerous it is to be a patient in our healthcare system.
Many healthcare organizations, such as the Center for Patient Safety, the Alliance for Patient Medication Safety, and the Agency for Healthcare Research and Quality have been formed to address the issue. The American College of Surgeons Committee on Trauma requires trauma centers to demonstrate a commitment to patient safety by coupling it with their quality improvement program. The trauma center verification guidelines refer to the “performance improvement and patient safety (PIPS)” process as a core requirement.
Attention to safety may also be required by accrediting authorities such as the Commission on Accreditation of Ambulance Services (CAAS) or through state and local licensing bodies.
Many organizations have made an effort to not just check the safety box, but truly incorporate concepts of safety into the actual culture of the system. This transformation from being reactionary to accidents and incidents, to building a safety culture, is not easy or quick but it does benefit both patients and healthcare workers. Many efforts have been designed to reduce harm to patients and bad outcomes, but the change in culture and the efforts to view all practices and processes with a safety lens also spill over to improving EMS provider safety.
Areas of concern for patient safety include:
- Falls
- Medication errors
- Hand-off miscommunications
- Infections
Likewise, top EMS provider threats begin with:
- Vehicle crashes
- Patient violence
- Roadway scene hazards
- Lifting and moving patients
Assessing your organization’s safety
An important step in building an EMS safety culture is conducting an objective assessment to identify the areas where the agency is doing well and to prioritize those that need the most attention. This assessment may be done internally or by bringing in safety experts to provide an unbiased look at the program.
The Center for Patient Safety (CPS) is one such organization. The CPS provides EMS agencies with a Patient Safety Culture Survey measuring 12 dimensions of patient safety. The dimensions are derived from the 11 patient safety domains identified in the 2018 research by the CPS and the National Association of EMTs, titled “Psychometric Analysis of a Survey on Patient Safety Culture-Based Tool for Emergency Medical Services.” The article was published in the Journal of Patient Safety.
The 12 critical areas measured in the Patient Safety Culture Survey are:
- Information exchange
- Overall perceptions of patient safety
- Teamwork
- Response to mistakes
- Staff training
- Organizational learning
- Handoffs
- Leadership support for patient safety
- Communications
- Staffing, work pressure, and pace
- Feedback and communication about incidents
- Communication during a response
Once an organization completes the culture survey, CPS provides an in-depth analysis of the agency, which includes:
- Results from previous surveys
- Results broken down by station/location
- Comparison to other similar agencies through the CPS benchmarking database
Results are analyzed and displayed in a variety of formats to facilitate interpretation and help leaders to make changes in the organization.
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Kick off new safety initiatives
Armed with a better understanding of the organization’s current safety culture and knowledge of the dimensions of an effective safety program, leaders will be better prepared to kick off new safety initiatives within the service.
Equipment and training to improve safety can be expensive and involve significant staff time, without directly yielding any revenue, so budget-conscious mangers will understandably give them a hard look. Proposals to leadership or oversight boards can be framed to identify and address the appropriate dimensions and justify the expense. Use of follow up assessments in the future will offer objective measurement of new initiative effectiveness.
Begin your organization’s transformation into a program that puts patient and provider safety first by participating in a safety culture survey.
