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Healthcare
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Quality of Pre-hospital Care
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Quality of Pre-hospital Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Prehospital Care".

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 8419

Special Issue Editors

Dr. Jason Scott

E-Mail Website
Guest Editor
Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
Interests: healthcare quality; patient safety; care transitions; pre-hospital care; frequent use
Prof. Dr. Gina Agarwal

E-Mail Website
Guest Editor
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
Interests: emergency medical systems (EMS) call volumes; avoidable EMS calls; frequent use; ambulatory care sensitive conditions (ACSCs)
Prof. Dr. Peter McMeekin

E-Mail Website
Guest Editor
Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
Interests: stroke and emergency medicine; pre-hospital care; care of older people; quality of life; diagnostics; transformation and change in healthcare; health economics
Prof. Dr. Christoph Redelsteiner

E-Mail Website
Guest Editor
Departments of Social Work and Health, University of Applied Sciences, St. Pölten, Austria
Interests: emergency medical service; acute care resource planning and allocation; crisis intervention; interface EMS and social work

Special Issue Information

Dear Colleagues,

Pre-hospital care is an important component of health systems, traditionally consisting of emergency medical services providing emergency treatment and conveying patients to emergency departments. The role of pre-hospital healthcare provision has rapidly evolved in recent decades. With this evolution, there has been an increased emphasis on the quality of care delivered to patients within the pre-hospital care setting, which now also includes the addressing of urgent and, in some cases, primary care needs. This is perhaps best demonstrated by the increasing emphasis on the development of quality indicators specific to pre-hospital care providers, as well as the professionalization agenda in emergency medical services. 

Therefore, we are pleased to invite you to submit original studies and review articles that contribute to our understanding of the quality of pre-hospital care. We are interested in receiving articles consisting of any relevant and robust methodology, including quantitative, qualitative and mixed-methods studies. Studies can focus on any element of care quality, such as patient experience, access to services, inequalities in care provision, patient safety, and interventions aiming to improve clinical and service-level outcomes. More specific suggested themes include but are not limited to:

  • Development or evaluation of pre-hospital care pathways;
  • Definitions of quality and/or quality indicators, including feedback systems for pre-hospital care staff or services to obtain final patient outcomes;
  • Patient experience or satisfaction with pre-hospital care;
  • Interventions situated within pre-hospital care setting that aim to improve access to care, patient safety or effectiveness;
  • Professional roles (including professionalization) and staff training initiatives aimed at improving quality of care;
  • Collaborative working within the pre-hospital care workforce and across organizational and professional boundaries, such as emergency department handover;
  • Staff satisfaction and wellbeing initiatives and their links to healthcare quality and patient safety;
  • Monitoring and evaluation of patient care related to Stroke, Acute Coronary Syndrome, Sepsis, Traumatic Brain Injury, Sudden Cardiac Arrest and Multiple Trauma (“EMS tracer diagnoses”). 

We look forward to receiving your contributions and welcome any expression of interest.

Dr. Jason Scott
Prof. Dr. Gina Agarwal
Prof. Dr. Peter McMeekin
Prof. Dr. Christoph Redelsteiner
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • emergency medical services
  • pre-hospital care
  • patient safety
  • healthcare quality
  • leadership
  • patient experience
  • quality indicators
  • care pathways
  • triage
  • staff wellbeing

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

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8 pages, 500 KiB  
Article
The Bleeding Must Be Stopped! Management in the Situation of Hemorrhages—A Prospective Randomized Controlled Prospective Simulation Study
by Michal Starosolski, Alicja Kalemba, Cezary Kaplan, Karolina Majewska and Krzysztof Ulbrich
Healthcare 2024, 12(23), 2370; https://doi.org/10.3390/healthcare12232370 - 26 Nov 2024
Viewed by 979
Abstract
Introduction: In a pre-hospital setting, uncontrolled hemorrhages in patients are undoubtedly a highly stressful situation for the rescuing medic, demanding prompt intervention. The effective stopping of a hemorrhage significantly reduces the risk of death for victims. The purpose of this study is to [...] Read more.
Introduction: In a pre-hospital setting, uncontrolled hemorrhages in patients are undoubtedly a highly stressful situation for the rescuing medic, demanding prompt intervention. The effective stopping of a hemorrhage significantly reduces the risk of death for victims. The purpose of this study is to evaluate the students’ chosen methods and the effectiveness of their actions during a simulated hemorrhage situation. In addition, the students’ behavior and their cognitive overload classified using the NASA scale were also analyzed. Methods: The study enrolled 101 medical students, who were randomized and assigned sequentially to a study group (n = 49) and a control group (n = 52). The research group participated in a training course. Both groups then proceeded to a simulated hemorrhage scenario in a patient in a pre-hospital setting. Finally, the students assessed their cognitive overload using the NASA scale. Results: After the training, more students have achieved effective bleeding control (36/49, 73.5% vs. 22/52, 42.3%, p = 0.002). The prevalent method of bleeding control in both groups was using a tourniquet (97/101, 96%) with or without additional gauze and bandages. A significant improvement in the technique of the tourniquet application was observed—in the control group, 23/52 students (47.9%) applied it properly, while in the study group, it was 36/49 (73.5%). This resulted in a shorter time to achieve effective bleeding control and lower blood loss in the study group (p = 0.013 and p = 0.034, respectively). The median blood loss was 32 mL (IQR = 24, range 11–65 mL) in the study group compared to 53 mL (IQR = 26, range 10–117 mL) in the control group. Conclusions: The education program for young medics needs changes, including an increased emphasis on learning procedures and improving practical skills. Full article
(This article belongs to the Special Issue Quality of Pre-hospital Care)
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13 pages, 587 KiB  
Article
Perceptions of Patient Safety Culture among Triage Nurses in the Emergency Department: A Cross-Sectional Study
by Zvonka Fekonja, Sergej Kmetec, Nataša Mlinar Reljić, Jožica Černe Kolarič, Majda Pajnkihar and Matej Strnad
Healthcare 2023, 11(24), 3155; https://doi.org/10.3390/healthcare11243155 - 12 Dec 2023
Cited by 1 | Viewed by 3018
Abstract
The patient safety culture is key to ensuring patient safety in healthcare organizations. The triage environment is inherently demanding for patient safety and is characterized by high stress, rapid decision-making, and quick action. In several countries, including Slovenia, there is a lack of [...] Read more.
The patient safety culture is key to ensuring patient safety in healthcare organizations. The triage environment is inherently demanding for patient safety and is characterized by high stress, rapid decision-making, and quick action. In several countries, including Slovenia, there is a lack of studies on the patient safety culture among triage nurses. This study aimed to assess the perceptions of the patient safety culture among triage nurses. A cross-sectional survey design was used. The Emergency Medical Services-Safety Attitudes Questionnaire, distributed to triage nurses, was used to collect data. A total of 201 triage nurses participated in this study. The results revealed that the overall average perception of the patient safety culture was 57.27% (SD = 57.27), indicating that the perception of the patient safety culture among triage nurses in the emergency department was non-positive and requires improvement. “Job Satisfaction” received the highest score (63.18%; SD = 17.19), while “Working Conditions” received the lowest (49.91%; SD = 17.37). The perception of positive and negative safety culture responses was statistically significant for age (χ2 (3) = 17.750, p ≤ 0.001), education (χ2 (2) = 6.957, p = 0.031) and length of working experience (χ2 (3) = 8.875, p = 0.031). The findings emphasize the significance of improving the safety culture in relation to several areas of patient care during the triage process. This research serves as a crucial foundation for enhancing patient safety in triage, providing quality care, and reducing adverse events. Full article
(This article belongs to the Special Issue Quality of Pre-hospital Care)
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19 pages, 1130 KiB  
Article
Feedback for Emergency Ambulance Staff: A National Review of Current Practice Informed by Realist Evaluation Methodology
by Caitlin Wilson, Gillian Janes, Rebecca Lawton and Jonathan Benn
Healthcare 2023, 11(16), 2229; https://doi.org/10.3390/healthcare11162229 - 8 Aug 2023
Cited by 4 | Viewed by 2928
Abstract
Research suggests that feedback in Emergency Medical Services (EMS) positively affects quality of care and professional development. However, the mechanisms by which feedback achieves its effects still need to be better understood across healthcare settings. This study aimed to understand how United Kingdom [...] Read more.
Research suggests that feedback in Emergency Medical Services (EMS) positively affects quality of care and professional development. However, the mechanisms by which feedback achieves its effects still need to be better understood across healthcare settings. This study aimed to understand how United Kingdom (UK) ambulance services provide feedback for EMS professionals and develop a programme theory of how feedback works within EMS, using a mixed-methods, realist evaluation framework. A national cross-sectional survey was conducted to identify feedback initiatives in UK ambulance services, followed by four in-depth case studies involving qualitative interviews and documentary analysis. We used qualitative content analysis and descriptive statistics to analyse survey responses from 40 prehospital feedback initiatives, alongside retroductive analysis of 17 interviews and six documents from case study sites. Feedback initiatives mainly provided individual patient outcome feedback through “pull” initiatives triggered by staff requests. Challenges related to information governance were identified. Our programme theory of feedback to EMS professionals encompassed context (healthcare professional and organisational characteristics), mechanisms (feedback and implementation characteristics, psychological reasoning) and outcomes (implementation, staff and service outcomes). This study suggests that most UK ambulance services use a range of feedback initiatives and provides 24 empirically based testable hypotheses for future research. Full article
(This article belongs to the Special Issue Quality of Pre-hospital Care)
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16 pages, 732 KiB  
Systematic Review
Systematic Review of Prehospital Prediction Models for Identifying Intracerebral Haemorrhage in Suspected Stroke Patients
by Mohammed Almubayyidh, Ibrahim Alghamdi, David Jenkins and Adrian Parry-Jones
Healthcare 2025, 13(8), 876; https://doi.org/10.3390/healthcare13080876 - 11 Apr 2025
Viewed by 325
Abstract
Introduction: The prompt prehospital identification of intracerebral haemorrhage (ICH) may allow very early delivery of treatments to limit bleeding. Current prehospital stroke assessment tools have limited accuracy for the detection of ICH as they were designed to recognise all strokes, not ICH specifically. [...] Read more.
Introduction: The prompt prehospital identification of intracerebral haemorrhage (ICH) may allow very early delivery of treatments to limit bleeding. Current prehospital stroke assessment tools have limited accuracy for the detection of ICH as they were designed to recognise all strokes, not ICH specifically. This systematic review aims to evaluate the performance of prehospital models in distinguishing ICH from other causes of suspected stroke. Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following a predefined strategy, we searched three electronic databases via Ovid (MEDLINE, EMBASE, and CENTRAL) in July 2023 for studies published in English, without date restrictions. Subsequently, data extraction was performed, and methodological quality was assessed using the Prediction Model Risk of Bias Assessment Tool. Results: After eliminating duplicates, 6194 records were screened for titles and abstracts. After a full-text review of 137 studies, 9 prediction studies were included. Five of these described prediction models were designed to differentiate between stroke subtypes, three distinguished between ICH and ischaemic stroke, and one model was developed specifically to identify ICH. All studies were assessed as having a high risk of bias, particularly in the analysis domain. The performance of the models varied, with the area under the receiver operating characteristic curve ranging from 0.73 to 0.91. The models commonly included the following as predictors of ICH: impaired consciousness, headache, speech or language impairment, high systolic blood pressure, nausea or vomiting, and weakness or paralysis of limbs. Conclusions: Prediction models may support the prehospital diagnosis of ICH, but existing models have methodological limitations, making them unreliable for informing practice. Future studies should aim to address these identified limitations and include a broader range of suspected strokes to develop a practical model for identifying ICH. Combining prediction models with point-of-care tests might further improve the detection accuracy of ICH. Full article
(This article belongs to the Special Issue Quality of Pre-hospital Care)
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