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Mahran GSK, Mekawy MM, Abd El-Aziz WW, Ali AFA, El Demerdash DA, Sayed MMM. Developing and Validating a Bundle for Safe Intra-Hospital Transporting of the Critically Ill Patients: Mixed Qualitative Design With Delphi Approach. Crit Care Nurs Q 2024; 47:378-399. [PMID: 39265117 DOI: 10.1097/cnq.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
The aim of this study was to develop a bundle to increase safety of intra-hospital transport in critically ill patients. A qualitative design with Delphi approach was conducted for creation of an intra-hospital transport bundle in 3 steps. First, doctors and nurses were questioned about their encounters with intra-hospital transport incidents. Second, several databases were looked through to find published checklists and recommendations for intra-hospital transport. Third, using this strategy, a bundle was created and reviewed with subject matter experts. The content validity index (CVI), which assesses the degree of expert agreement, was utilized to evaluate each item in the generated bundle. Two evaluation cycles were required before a minimal index could be reached. We looked at the content validity and important weighting of the items. The scale-CVI was calculated using the average of all the elements, and it was 1. The created bundle serves as a framework for directing doctors and nurses during intra-hospital transportation and offers continuity of care to improve patient safety. The techniques suggested in this study can be used to adapt this bundle to the needs of other hospitals.
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Affiliation(s)
- Ghada Shalaby Khalaf Mahran
- Author Affiliations: Department of Critical Care and Emergency Nursing, Faculty of Nursing (Dr Mahran), Department of Anesthesia and Intensive care, Faculty of Medicine (Dr Sayed), Assiut University, Assiut, Egypt; Department of Medical Surgical Nursing, Faculty of Nursing, Galala University, Suez, Egypt (Drs Mekawy and El Demerdash); and Department of Critical Care and Emergency Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt (Drs Abd El-Aziz and Ali)
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Matias ARC, Sá FLFRGD. Intervenções da equipe multiprofissional no transporte de pacientes em estado crítico: revisão sistemática de métodos mistos. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0452pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Analisar como intervenções da equipe multiprofissional promovem a segurança no transporte de pacientes em estado crítico. Método Revisão sistemática de métodos mistos elaborada com as recomendações do Joanna Briggs Institute, seguindo uma abordagem integrada convergente. A pesquisa foi realizada nas bases de dados MEDLINE, CINAHL, Cochrane Database of Systematic Reviews e Cochrane Central Register of Controlled Trials, resultando em 107 estudos. Após a remoção de estudos duplicados e a aplicação de critérios de inclusão e exclusão, 17 estudos foram avaliados quanto à sua qualidade metodológica, havendo 15 estudos na amostra final. A extração dos dados foi realizada por um instrumento em forma de tabela e sintetizada por meio de análise temática. Resultados A decisão ponderada, o planejamento, a atuação na resolução de problemas e a ação para a melhoria são intervenções que a equipe multiprofissional promove na segurança do transporte de pacientes em estado crítico. Conclusão e implicações para a prática A padronização do transporte (criação de protocolos institucionais, check-list e adequação de equipamentos), a educação permanente e o treinamento de competências na capacitação das equipes fomentam uma cultura de segurança que evita o dano ao paciente. Sugerem-se pesquisas sobre a dimensão subjetiva e a inclusão da família no transporte.
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Matias ARC, Sá FLFRGD. Multiprofessional team interventions in transporting critically ill patients: a systematic mixed-methods review. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0452en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Aim To analyze how interventions of a multidisciplinary team promote the safe transportation of critically ill patients. Method A systematic mixed-methods review was developed using an integrated convergent approach according to the Joanna Briggs Institute. This study was conducted using MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials electronic databases, which generated 107 references. After removing duplicates and applying inclusion and exclusion criteria, 17 articles were evaluated for methodological quality, resulting in 15 articles as the final sample. Data extraction was performed using a tool in the form of a table and synthesized through thematic analysis. Results Thoughtful decision, planning, problem-solving action and action for improvement are interventions that the multiprofessional team promotes the safe transportation of critically ill patients. Conclusion and implications for practice The standardization of transport (institutional protocols, a checklist, and equipment adequacy), continuing education, and skills training in the capacitation of teams foster a culture of safety that prevents harm to the patient. Further research is suggested on the subjective dimension and with the family in transportation.
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Schumacher L, Berthaudin F, Blanc AL, Blatrie C, Staines A, Bonnabry P, Widmer N. Using risk analysis to ensure patients' medication safety during hospital relocations and evacuations. Eur J Hosp Pharm 2021; 28:e171-e179. [PMID: 33832916 DOI: 10.1136/ejhpharm-2020-002619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To ensure patient safety and the preparedness of medication processes during hospital relocations and evacuations by using Failure Modes, Effects, and Criticality Analysis (FMECA). METHODS The relocation of six regional hospitals to a single building, resulting in 400 beds being moved, could be compared with an emergency evacuation. An FMECA was performed on the hospital group's internal medicine and intensive care units (IMU and ICU), examining how medication processes would be affected by a hospital relocation or evacuation. RESULTS We identified 59 hospital relocation and 68 evacuation failure modes. Failure modes were ranked based on their criticality index (CI; range 1-810). The higher the CI, the greater the patient-related risk. Average initial IMU and ICU hospital relocation CI scores were 160 (range 105-294) and 201 (range 125-343), respectively, subsequently reduced to 32 (-80%) and 49 (-76%) after mitigation measures. Average initial IMU and ICU evacuation CI scores were 319 (range 245-504) and 592 (range 441-810), respectively, subsequently reduced to 194 (-39%) and 282 (-52%). Most mitigation measures (17/22), such as for example checklists, could be implemented in both situations. Due to their unpredictable nature, five measures were specific to evacuation situations. CONCLUSIONS This study highlights the value of using an FMECA on medication processes to anticipate potential negative impacts on patient safety during hospital relocations or evacuations. Preparation for a hospital relocation can provide useful knowledge and an opportunity to test mitigation measures that might prove useful in evacuations.
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Affiliation(s)
- Laurence Schumacher
- Pharmacy of Eastern Vaud Hospitals, Rennaz, Switzerland.,Specialised Centre for Emergency and Disaster Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Florian Berthaudin
- Specialised Centre for Emergency and Disaster Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | | | | | - Anthony Staines
- Vaud Hospital Federation, Prilly, Switzerland.,Université Jean Moulin Lyon 3 IFROSS, Lyon, Auvergne-Rhône-Alpes, France
| | - Pascal Bonnabry
- Specialised Centre for Emergency and Disaster Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Pharmacy of the Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Widmer
- Pharmacy of Eastern Vaud Hospitals, Rennaz, Switzerland .,Specialised Centre for Emergency and Disaster Pharmacy, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Hu Y, Shi D, You L, Li W. Intrahospital transport of critically ill patients: A survey of emergency nurses. Nurs Crit Care 2021; 26:326-332. [PMID: 33569896 DOI: 10.1111/nicc.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the frequency of its occurrence, few Chinese studies examined the status of intrahospital transport (IHT) of critically ill emergency room patients. AIMS AND OBJECTIVES To investigate the current status of IHT of critically ill patients and emergency nurses' perception of IHT across China; explore the perceived associations of written protocols with adverse events during IHT; and compare regional differences in IHT of critically ill patients across China. DESIGN A self-report questionnaire was conducted among the attendees of a large emergency medicine conference in Beijing in May 2015. METHODS The data, collected through convenience sampling, were analysed using descriptive statistics. Categorical variables were compared using the chi-squared test. RESULTS Of the 528 participants from 142 hospitals whose data were analysed, 19.3% considered all nurses competent enough to perform IHT of critically ill patients without special training, and 7.6% even considered nursing students capable of the task. The absence of written transport protocols was perceived to be significantly associated with the occurrence of adverse events such as oxygen supply depletion and incorrect destination. Hospitals in the western region were less likely to have established written IHT protocols and emergency checklists than those in the eastern region. CONCLUSIONS Safe IHT of critically ill patients in the emergency department involves enormous challenges. The results of this survey can facilitate a preliminary understanding of the characteristics and current situation of IHT in emergency settings across China. RELEVANCE TO CLINICAL PRACTICE The establishment of standard transport protocols may help reduce the incidence of adverse events.
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Affiliation(s)
- Yingli Hu
- Outpatient Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Donglei Shi
- Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lili You
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Lin SJ, Tsan CY, Su MY, Wu CL, Chen LC, Hsieh HJ, Hsiao WL, Cheng JC, Kuo YW, Jerng JS, Wu HD, Sun JS. Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness. BMJ Open Qual 2021; 9:bmjoq-2019-000698. [PMID: 32317274 PMCID: PMC7202726 DOI: 10.1136/bmjoq-2019-000698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
Aim Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation. Design and implementation We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme. Results The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001). Conclusion The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.
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Affiliation(s)
- Shwu-Jen Lin
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Yuan Tsan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Jung Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Chen Cheng
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wen Kuo
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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7
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Affiliation(s)
- Odette Comeau
- Odette Comeau is an adult critical care clinical nurse specialist at the University of Texas Medical Branch, Galveston, Texas
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8
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Geldenhuys L, Wise R, Rodseth R. The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.3.2343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L Geldenhuys
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Wise
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Rodseth
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
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Salt O, Akpınar M, Sayhan MB, Örs FB, Durukan P, Baykan N, Kavalcı C. Intrahospital critical patient transport from the emergency department. Arch Med Sci 2020; 16:337-344. [PMID: 32190144 PMCID: PMC7069436 DOI: 10.5114/aoms.2018.79598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/29/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Although intrahospital transportation of critical patients from the emergency department (ED) is inevitable, it could also result in life-threatening situations. These situations, referred to as unwanted or unexpected events, mainly happen during the transportation of patients for diagnostic imaging or invasive procedures and result in a wide spectrum from vital condition changes, mental condition changes to cardiopulmonary arrest and death. Emergency departments have a high risk of facing such situations because these units are the first admission door of critical patients. MATERIAL AND METHODS This cross-sectional study was conducted prospectively, after interviewing the doctors who work in the ED actively, and by filling out the forms which were already prepared by the participants. Statistical analysis was performed according to the data received, and results were compared to the literature. RESULTS Three hundred and forty-seven doctors from 52 hospitals were included in the study. 59.4% (n = 206) of them were working at EDs which had more than 500 patients admitted. 51.9% (n = 180) of doctors stated that they performed 10 or more critical patients' transport every day from their ED. 86.7% (n = 301) of the participants stated that usage of control checklists would decrease the rate of unwanted situations and stated that they wanted to use them. CONCLUSIONS Intrahospital transportation of critical patients from the emergency room is a subject that should require attention by emergency room doctors, and using educated personnel, proper equipment, standardized protocols and control checklists will decrease the frequency of unwanted situations effectively.
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Affiliation(s)
- Omer Salt
- Department of Emergency Medicine, Trakya University, Edirne, Turkey
| | - Metin Akpınar
- Department of Emergency Medicine, Van Training and Research Hospital, Van, Turkey
| | | | - Fatma Betül Örs
- Department of Emergency Medicine, Trakya University, Edirne, Turkey
| | - Polat Durukan
- Department of Emergency Medicine, Erciyes University, Kayseri, Turkey
| | - Necmi Baykan
- Department of Emergency Medicine, Nevşehir State Hospital, Nevşehir, Turkey
| | - Cemil Kavalcı
- Department of Emergency Medicine, Başkent University, Ankara, Turkey
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10
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A checklist for intrahospital transport of critically ill patients improves compliance with transportation safety guidelines. Aust Crit Care 2019; 33:20-24. [PMID: 30981603 DOI: 10.1016/j.aucc.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Critically ill patients are often transferred from the intensive care unit (ICU) to other locations around the hospital during which adverse events, some life threatening, are common. An intercollegiate guideline covering the transport of critically ill patients exists in Australasia; however, compliance with this guideline has previously been shown to be poor, and its role in improving safety in transportation of patients in the ICU is unknown. We performed a pre-post interventional study in a tertiary metropolitan ICU, assessing the impact of the introduction of a transport checklist on guideline compliance. METHODS We performed a prospective, pre-post interventional study, including a total of 76 transfers of critically ill patients between August 2016 and April 2017. RESULTS After introduction of the checklist, aggregate median (interquartile range) guideline compliance improved from 86.7% (80.0-92.9) to 90% (86.7-100) (p = 0.01). Significant improvements were found in notification of the transport destination (83.7% vs 100%, p = 0.010) and transporting doctors' knowledge of the Cormack-Lehane grade of laryngoscopy (60.5% vs. 84.2%, p = 0.021). There was, however, a reduction in the proportion of full oxygen cylinders taken on transports (100% vs. 76.3%, p = 0.002). CONCLUSIONS We conclude that a checklist is useful in improving safety in the transport of a critically ill patient population.
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11
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Zauszniewski JA, Bekhet A, Herbell K. Comprehensive evaluation of interventions: eight vital parameters. Nurse Res 2018; 26:20-25. [PMID: 30474362 DOI: 10.7748/nr.2018.e1603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is critically important to determine the effectiveness of an intervention before it can be translated into clinical practice. However, the future implementation and sustainability of the intervention may be diminished if other intervention parameters are not assessed. This requires obtaining feedback from intervention recipients so interventions will be perceived as appealing, relevant, meaningful and beneficial to them; otherwise recipients may be unlikely to perform them over time, resulting in unsuccessful health outcomes. AIM To propose the addition of two intervention parameters to the existing six-parameter model and provide examples from recent research of how each parameter can be tested. DISCUSSION Definitions of the eight parameters are provided and methods for analysing each of them explained. While some studies show necessity, fidelity and cost have unique distinguishing characteristics, other studies indicate feasibility, acceptability and safety have common features, and efficacy and effectiveness are closely associated. CONCLUSION Researchers frequently examine one or two parameters, but few simultaneously apply the six-parameter model. This model is also missing two vital parameters - efficacy and cost. IMPLICATIONS FOR PRACTICE Comprehensive and systematic evaluation of all eight intervention parameters is recommended before researchers begin randomised controlled trials and translate them into practice.
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Affiliation(s)
| | - Abir Bekhet
- Marquette University, Milwaukee, Wisconsin, United States
| | - Kayla Herbell
- Sinclair School of Nursing, University of Missouri, United States
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Goforth C, Bradley M, Pineda B, See S, Pasley J. Resuscitative Endovascular Balloon Occlusion of the Aorta: A Bridge to Flight Survival. Crit Care Nurse 2018; 38:69-75. [PMID: 29606678 DOI: 10.4037/ccn2018853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Trauma endures as the leading cause of death worldwide, and most deaths occur in the first 24 hours after initial injury as a result of hemorrhage. Historically, about 90% of battlefield deaths occur before the injured person arrives at a theater hospital, and most are due to noncompressible hemorrhage of the torso. Resuscitative endovascular balloon occlusion of the aorta is an evolving technique to quickly place a balloon into the thoracic or abdominal aorta to efficiently block blood flow to distal circulation. Maneuvers, such as resuscitative endovascular balloon occlusion of the aorta, to control endovascular hemorrhage offer a potential intervention to control noncompressible hemorrhage. This technique can be performed percutaneously or open in prehospital environments to restore hemodynamic functions and serve as a survival bridge until the patient is delivered to a treatment facility for definitive surgical hemostasis. This article describes the indications, complications, and application of resuscitative endovascular balloon occlusion of the aorta to military and civilian aeromedical transport.
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Affiliation(s)
- Carl Goforth
- CDR Carl Goforth, NC, USN, is a nurse researcher, Naval Medical Research Center, Silver Spring, Maryland, and Uniformed Services University of the Health Sciences, Bethesda, Maryland. .,CDR Matthew Bradley, NC, USN, is a staff surgeon at Walter Reed National Military Medical Center, Bethesda, Maryland, and is conducting research on resuscitation at the Naval Medical Research Center, Silver Spring, Maryland. .,MAJ Benilani Pineda, ANC, USA, is the former director, Joint En Route Care Course, Fort Rucker, Alabama. She is currently serving in the National Capital Region, US Army Executive Medicine, Washington, DC. .,Maj Suzanne See, USAF, NC, is a trauma educator at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center, Baltimore, Maryland. .,Lt Col Jason Pasley, USAF, MC, a board-certified trauma surgeon, is the director of physician education at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center. He also is a core faculty member of the American College of Surgeons basic endovascular skills for trauma course.
| | - Matthew Bradley
- CDR Carl Goforth, NC, USN, is a nurse researcher, Naval Medical Research Center, Silver Spring, Maryland, and Uniformed Services University of the Health Sciences, Bethesda, Maryland.,CDR Matthew Bradley, NC, USN, is a staff surgeon at Walter Reed National Military Medical Center, Bethesda, Maryland, and is conducting research on resuscitation at the Naval Medical Research Center, Silver Spring, Maryland.,MAJ Benilani Pineda, ANC, USA, is the former director, Joint En Route Care Course, Fort Rucker, Alabama. She is currently serving in the National Capital Region, US Army Executive Medicine, Washington, DC.,Maj Suzanne See, USAF, NC, is a trauma educator at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center, Baltimore, Maryland.,Lt Col Jason Pasley, USAF, MC, a board-certified trauma surgeon, is the director of physician education at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center. He also is a core faculty member of the American College of Surgeons basic endovascular skills for trauma course
| | - Benilani Pineda
- CDR Carl Goforth, NC, USN, is a nurse researcher, Naval Medical Research Center, Silver Spring, Maryland, and Uniformed Services University of the Health Sciences, Bethesda, Maryland.,CDR Matthew Bradley, NC, USN, is a staff surgeon at Walter Reed National Military Medical Center, Bethesda, Maryland, and is conducting research on resuscitation at the Naval Medical Research Center, Silver Spring, Maryland.,MAJ Benilani Pineda, ANC, USA, is the former director, Joint En Route Care Course, Fort Rucker, Alabama. She is currently serving in the National Capital Region, US Army Executive Medicine, Washington, DC.,Maj Suzanne See, USAF, NC, is a trauma educator at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center, Baltimore, Maryland.,Lt Col Jason Pasley, USAF, MC, a board-certified trauma surgeon, is the director of physician education at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center. He also is a core faculty member of the American College of Surgeons basic endovascular skills for trauma course
| | - Suzanne See
- CDR Carl Goforth, NC, USN, is a nurse researcher, Naval Medical Research Center, Silver Spring, Maryland, and Uniformed Services University of the Health Sciences, Bethesda, Maryland.,CDR Matthew Bradley, NC, USN, is a staff surgeon at Walter Reed National Military Medical Center, Bethesda, Maryland, and is conducting research on resuscitation at the Naval Medical Research Center, Silver Spring, Maryland.,MAJ Benilani Pineda, ANC, USA, is the former director, Joint En Route Care Course, Fort Rucker, Alabama. She is currently serving in the National Capital Region, US Army Executive Medicine, Washington, DC.,Maj Suzanne See, USAF, NC, is a trauma educator at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center, Baltimore, Maryland.,Lt Col Jason Pasley, USAF, MC, a board-certified trauma surgeon, is the director of physician education at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center. He also is a core faculty member of the American College of Surgeons basic endovascular skills for trauma course
| | - Jason Pasley
- CDR Carl Goforth, NC, USN, is a nurse researcher, Naval Medical Research Center, Silver Spring, Maryland, and Uniformed Services University of the Health Sciences, Bethesda, Maryland.,CDR Matthew Bradley, NC, USN, is a staff surgeon at Walter Reed National Military Medical Center, Bethesda, Maryland, and is conducting research on resuscitation at the Naval Medical Research Center, Silver Spring, Maryland.,MAJ Benilani Pineda, ANC, USA, is the former director, Joint En Route Care Course, Fort Rucker, Alabama. She is currently serving in the National Capital Region, US Army Executive Medicine, Washington, DC.,Maj Suzanne See, USAF, NC, is a trauma educator at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center, Baltimore, Maryland.,Lt Col Jason Pasley, USAF, MC, a board-certified trauma surgeon, is the director of physician education at the Center for the Sustainment of Trauma and Readiness Skills, R. Adams Crowley Shock Trauma Center. He also is a core faculty member of the American College of Surgeons basic endovascular skills for trauma course
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Hatzfeld J, Foradori M. The Critical Link Between Acute Care Nursing and Military En Route Care. Crit Care Nurse 2018; 38:13-15. [PMID: 29606671 DOI: 10.4037/ccn2018971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jennifer Hatzfeld
- Lt Col Jennifer Hatzfeld entered active duty as a nurse in the US Air Force in 1995. She is the executive director of the TriService Nursing Research Program, Bethesda, Maryland. .,Megan Foradori is the research interest group coordinator at TriService Nursing Research Program, Bethesda, Maryland.
| | - Megan Foradori
- Lt Col Jennifer Hatzfeld entered active duty as a nurse in the US Air Force in 1995. She is the executive director of the TriService Nursing Research Program, Bethesda, Maryland.,Megan Foradori is the research interest group coordinator at TriService Nursing Research Program, Bethesda, Maryland
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Yang SH, Jerng JS, Chen LC, Li YT, Huang HF, Wu CL, Chan JY, Huang SF, Liang HW, Sun JS. Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system. BMJ Open 2017; 7:e017932. [PMID: 29101141 PMCID: PMC5695373 DOI: 10.1136/bmjopen-2017-017932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. OBJECTIVE To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. SETTING A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. PARTICIPANTS All eligible IHT-related patient safety events between January 2010 to December 2015 were included. MAIN OUTCOME MEASURES Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. RESULTS There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (p<0.001). Of the events with human failures (n=186), the most common related process step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, p<0.001) was associated with increased patient harm, whereas the presence of omission (OR 0.12, p<0.001) was associated with less patient harm. CONCLUSIONS This study shows a need to reduce human failures to prevent patient harm during intra-hospital transportation. We suggest that the transportation team pay specific attention to the sub-process at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted.
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Affiliation(s)
- Shu-Hui Yang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tsu Li
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Fang Huang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Yuan Chan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Building a new hospital is an exciting time. However significant planning is required to prepare staff to assume care of patients in an environment with new workflow changes and new equipment. The challenges of this advanced preparation are compounded when the opening of the new hospital includes the planned move of the inpatient census of patients from an existing hospital to the new hospital. Goals and objectives on the move day include patient and staff safety, with a seamless transition to the new environment. This article describes the experiences and strategies used by an adult inpatient department to successfully open a new hospital.
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