title: Patient Safety Perceptions in Pediatric Out-of-Hospital Emergency Care: Children's Safety Initiative.
abstract: OBJECTIVE
  To characterize emergency medical service (EMS) providers' perceptions of the factors that contribute to safety events and errors in the out-of-hospital emergency care of children.
  
  
  METHODS
  We used a Delphi process to achieve consensus in a national sample of 753 emergency medicine physicians and EMS professionals. Convergence and stability were achieved in 3 rounds, and findings were reviewed and interpreted by a national expert panel.
  
  
  RESULTS
  Forty-four (88%) states were represented, and 66% of participants were retained through all 3 rounds. From an initial set of 150 potential contributing factors derived from focus groups and literature, participants achieved consensus on the following leading contributors: airway management, heightened anxiety caring for children, lack of pediatric skill proficiency, lack of experience with pediatric equipment, and family members leading to delays or interference with care. Somewhat unexpectedly, medications and communication were low-ranking concerns. After thematic analysis, the overarching domains were ranked by their relative importance: (1) clinical assessment; (2) training; (3) clinical decision-making; (4) equipment; (5) medications; (6) scene characteristics; and (7) EMS cultural norms.
  
  
  CONCLUSIONS
  These findings raise considerations for quality improvement and suggest important roles for pediatricians and pediatric emergency physicians in training, medical oversight, and policy development.
authors: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR; Department of Emergency Medicine, Oregon Health and Science University, Portland, OR; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR. Electronic address: guisej@ohsu.edu.
authors: Jeanne-Marie
authors: JM
authors: Guise
authors: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.
authors: Garth
authors: G
authors: Meckler
authors: Department of Psychology, Portland State University, Portland, OR.
authors: Kerth
authors: K
authors: O'Brien
authors: Department of Emergency Medicine, University of Arizona, Tucson, AZ.
authors: Merlin
authors: M
authors: Curry
authors: Public Health Division, Oregon Health Authority, Portland, OR.
authors: Phil
authors: P
authors: Engle
authors: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors: Caitlin
authors: C
authors: Dickinson
authors: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors: Kathryn
authors: K
authors: Dickinson
authors: Department of Emergency Medicine, Oregon Health and Science University, Portland, OR.
authors: Matthew
authors: M
authors: Hansen
authors: Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR.
authors: William
authors: W
authors: Lambert
mesh_terms: D000328:Adult; D002648:Child; D004630:Emergencies; D004632:Emergency Medical Services / Q000592:standards*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards*; D010465:Perception / Q000502:physiology*; D011050:Policy Making; D014481:United States