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Driving Quality Improvement Forward UNDERSTANDING PATIENT SAFETY EVENTS WITHIN BC EMERGENCY HEALTH SERVICES
ANNEMARIE TAYLOR, BCPSLS JAN BUTLER, BCEHS
What is a patient safety event for BCEHS? How is BCEHS different?
486,000 ground
events throughout
the province
394,000
pre-hospital (9-1-1)
events
92,000 inter-facility patient transfers
What are the impacts and outcomes?
When is a service issue a patient safety event?
• Timing of event awareness • Electronic access • Availability of patient outcome information • Causal relationship to harm
Vs
Considerations
Event reporting
Other Other Other
+
No relevant data Limited cultural uptake
Other Other Other
+
No relevant data Limited cultural uptake
What’s important to BCEHS? - Interfacility transfer?
- Patient Transfer Network involved?
- Phase of transport or transfer
- Lights and sirens?
- Discussed in safety huddle?
- BCEHS employee injured?
- Device or supply involved?
- Medication, IV, oxygen, blood involved?
- Language barrier a factor?
- Associated with handover?
- Transport or transfer related event?
- Patient handling (e.g. restraint in vehicle)
- Vehicular event (land or air)
- Involvement of second organization
- Patient harmed?
- Potential for severe harm?
- Who’s reporting?
What have we learned?
+300 QPins
Our team Annemarie Taylor, Provincial Director, BC PSLS [email protected]
Janice Butler, Corporate Director, Quality, Safety, Risk Management & Accreditation, BCEHS [email protected]
Sandra Christenson, Quality Assurance and Change Management Leader, BCPSLS [email protected]
George Papadopoulos, Director, Patient Safety, Quality & Accreditation, BCEHS [email protected]
Emily Hamilton, Leader, Patient Safety, Quality & Accreditation, BCEHS [email protected]
Mary MacKillop, Director, Patient Care Quality Office, PHSA [email protected]
