Factors influencing the perception of feeling safe in pre-hospital emergency care: A mixed-methods systematic review

Abstract

Aims: To systematically describe the factors influencing the perception of feeling safe among patients receiving pre-hospital emergency care.

Background: Patient safety is a top priority worldwide. Little is known about how patients perceive safety during emergency health care and what the related factors are.

Design: A mixed-methods systematic review.

Methods: Six databases were searched to December 2021. Inclusion criteria were as follows: studies with patients of any age, framed in pre-hospital emergency care settings, referring to patient safety, addressing the perception of safety, and with a quantitative or qualitative research design. Exclusion criteria were as follows: conference records, abstracts, supplements, letters, editorials and reviews. The quality of the evidence was assessed with the Joanna Briggs Institute (JBI) checklists. A convergent integrated approach was followed according to the JBI methodology. The protocol was registered on PROSPERO (CRD42022306337). PRISMA 2020 guidelines were followed in reporting this review.

Results: Among the 5223 records identified, the whole texts of 35 articles were reviewed. Ten studies were relevant to the research question. Seven followed a qualitative methodology, with interviews or focus group. Three involved a quantitative methodology, with questionnaires or validated measures. The 74 findings were organised into 11 categories and then grouped into four dimensions: 'receiving a satisfying response from healthcare professionals when I need it', 'EMS personnel's professional competence', 'the variable and unfamiliar settings of pre-hospital emergencies', and 'patients' personal characteristics'.

Conclusions: The perception of safety is influenced by many factors, which can be grouped into four independent dimensions. Quantitative and qualitative studies can provide us with complementary findings.

Relevance to clinical practice: Awareness of these factors enables us to act upon them. When patients feel safe their health outcomes improve, their anxiety decreases and they collaborate more actively.

No patient or public contribution: Patients and caregivers shared their experiences in the articles included.

Keywords: emergency medical services; feeling safe; feeling unsafe; patient safety; pre-hospital emergency care; related factors; systematic review.