Delphi consensus on Never Events in Emergency Medical Services—NEEMS-1-study
Hartwig Marung, Reinhard Strametz, Carla Nau, Matthias Lenz, Stefan Poloczek, Lukas Fritz, Holger MaurerBackground
Prehospital emergency care is often conducted under challenging conditions, creating a high-risk environment for both patients and healthcare professionals. However, safety in this setting has received limited attention. This study aimed to develop a limited, consensus-based set of safety indicators for emergency medical services (EMS) by adapting the “Never Event” concept to prehospital emergency care.
Methods
We conducted a three-round, web-based Delphi process in 2014 among experts in the field of emergency care to achieve consensus on Never Events specific to the prehospital environment. The primary outcome was the mean rating of item relevance on a 5-point Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”). Consensus was defined as a mean rating of ≥3.75 (75%) in rounds 1 and 2 and ≥2.5 in round 3.
Results
In total, 83 experts participated in round 1, and 68 completed rounds 2 and 3. The highest levels of agreement were reached for the following statements: “Patient death or serious disability associated with an airway management error,” “Omission of telephone-assisted CPR instructions despite identification of cardiac arrest and availability of trained personnel,” and “Patient death or serious disability associated with a medication error.” Overall, the expert panel regarded 32 events as “preventable by all means.”
Conclusions
Given the extensive list of 32 events, achieving the study goal of developing a limited set of EMS safety indicators appears doubtful. Further research is required to establish broad expert consensus on Never Events in EMS.