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Pedrosa L, Hoyos J, Reyes L, Mosteiro A, Zattera L, Topczewski T, Rodríguez-Hernández A, Amaro S, Torné R, Enseñat J. Brain metabolism response to intrahospital transfers in neurocritical ill patients and the impact of microdialysis probe location. Sci Rep 2024; 14:7388. [PMID: 38548829 PMCID: PMC10978944 DOI: 10.1038/s41598-024-57217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 03/15/2024] [Indexed: 04/01/2024] Open
Abstract
Intrahospital transfer (IHT), a routine in the management of neurocritical patients requiring imaging or interventions, might affect brain metabolism. Studies about IHT effects using microdialysis (MD) have produced conflicting results. In these studies, only the most damaged hemisphere was monitored, and those may not reflect the impact of IHT on overall brain metabolism, nor do they address differences between the hemispheres. Herein we aimed to quantify the effect of IHT on brain metabolism by monitoring both hemispheres with bilateral MD. In this study, 27 patients with severe brain injury (10 traumatic brain injury and 17 subarachnoid hemorrhage patients) were included, with a total of 67 IHT. Glucose, glycerol, pyruvate and lactate were measured by MD in both hemispheres for 10 h pre- and post-IHT. Alterations in metabolite levels after IHT were observed on both hemispheres; although these changes were more marked in hemisphere A (most damaged) than B (less damaged). Our results suggest that brain metabolism is altered after an IHT of neurocritical ill patients particularly but not limited to the damaged hemisphere. Bilateral monitorization may be more sensitive than unilateral monitorization for detecting metabolic disturbances not directly related to the course of the disease.
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Affiliation(s)
- Leire Pedrosa
- Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
- IDIBAPS Biomedical Research Institute, 08036, Barcelona, Spain
| | - Jhon Hoyos
- Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
| | - Luis Reyes
- Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
| | - Alejandra Mosteiro
- Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
| | - Luigi Zattera
- Department of Anesthesiology and Critical Care, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
| | - Thomaz Topczewski
- Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
| | - Ana Rodríguez-Hernández
- Department of Neurosurgery, Germans Trias i Pujol University Hospital, 08916, Badalona, Spain
| | - Sergio Amaro
- IDIBAPS Biomedical Research Institute, 08036, Barcelona, Spain
- Comprehensive Stroke Unit, Neurology, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
| | - Ramon Torné
- Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain.
- IDIBAPS Biomedical Research Institute, 08036, Barcelona, Spain.
- Comprehensive Stroke Unit, Neurology, Hospital Clinic of Barcelona, 08036, Barcelona, Spain.
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain
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Venter M, Stassen W. A national retrospective descriptive analysis of critical care transfers in the private sector in South Africa. S Afr Med J 2023; 113:38-43. [PMID: 37882134 DOI: 10.7196/samj.2023.v113i8.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Critical care transfers (CCTs) are necessitated by the growing prevalence of high-acuity patients who require upgrade of care to multidisciplinary teams from less-equipped referring facilities. Owing to the high acuity of the critical care patient, specialised teams with advanced training and equipment are called upon to undertake these transfers. The inherent understanding of the potential effects, and therefore the needs of the critical care patient during transfer, are affected owing to the paucity of international, but more specifically, local data relating to CCTs. OBJECTIVES To describe a cohort of patients who underwent CCT by dedicated critical care retrieval services (CCRS) in the private sector in South Africa (SA). METHODS This retrospective, descriptive study sampled all paediatric and adult CCTs completed over a 1-year period (1 January 2017 - 31 December 2017) from the dedicated CCRS of two national emergency medical services in SA. All neonatal patients were excluded. Data were extracted from patient report forms by trained data extractors and subjected to descriptive analysis. RESULTS A total of 1 839 patients were transferred between the two services. A total of 3 143 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent primary diagnosis was cardiovascular disease (n=457, 25%), followed by infection (n=180, 10%) and head injury (n=133, 7%). Patients had an average of ~3 attachments, with the most prevalent being patient monitoring (n=2 856, 155%), peripheral intravenous access (n=794, 43%) and mechanical ventilation (n=445, 24%). A total of 2 152 instances of medication infusion or administration were required during transport, yielding an average of ~1 medication or infusion per patient transported. The most common medications recorded were central nervous system depressants (n=588, 32%), followed by analgesics (n=482, 26%) and inotropic or vasoactive agents (n=320, 17%). CONCLUSION This study provides insight into the demographics, most prevalent diagnoses and interfacility transfer monitoring needs of patients being transported in SA by two private dedicated CCRS. The results of this study may be used to inform future specialised critical care transport courses and qualifications, equipment procurement and scopes of practice for providers undertaking critical care transfers.
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Affiliation(s)
- M Venter
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - W Stassen
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Ede J, Garry D, Barker G, Gustafson O, King E, Routley H, Biggs C, Lumley C, Bennett L, Payne S, Ellis A, Green C, Smith N, Vincent L, Holdaway M, Watkinson P. Building a Covid-19 secure intensive care unit: A human-centred design approach. J Intensive Care Soc 2023; 24:71-77. [PMID: 36860555 PMCID: PMC9204129 DOI: 10.1177/17511437221092685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The Covid-19 pandemic has highlighted weaknesses in the National Health Service critical care provision including both capacity and infrastructure. Traditionally, healthcare workspaces have failed to fully incorporate Human-Centred Design principles resulting in environments that negatively affect the efficacy of task completion, patient safety and staff wellbeing. In the summer of 2020, we received funds for the urgent construction of a Covid-19 secure critical care facility. The aim of this project was to design a pandemic resilient facility centred around both staff and patient requirements and safety, within the available footprint. Methods We developed a simulation exercise, underpinned by Human-Centred Design principles, to evaluate intensive care designs through Build Mapping, Tasks Analysis and Qualitative data. Build Mapping involved taping out sections of the design and mocking up with equipment. Task Analysis and qualitative data were collected following task completion. Results 56 participants completed the build simulation exercise generating 141 design suggestions (69 task related, 56 patient and relative related, 16 staff related). Suggestions translated to 18 multilevel design improvements; five significant structural changes (Macro level) including wall moves and lift size change. Minor improvements were made at a Meso and Micro design level. Critical care design drivers identified included functional drivers (visibility, Covid-19 secure environment, workflow, and task efficiency) and behavioural drivers (learning and development, light, humanising intensive care and design consistency). Conclusion Success of clinical tasks, infection control, patient safety and staff/patient wellbeing are highly dependent on clinical environments. Primarily, we have improved clinical design by focusing on user requirements. Secondly, we developed a replicable approach to exploring healthcare build plans revealing significant design changes, that may have only been identified once built.
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Affiliation(s)
- Jody Ede
- Oxford University Hospital NHS Foundation Trust, UK,School of Nursing and Midwifery, University of Plymouth, UK,Jody Ede, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Level 3, John Radcliffe Hospital, Oxford OX3 9DU, UK.
| | - David Garry
- Oxford University Hospital NHS Foundation Trust, UK
| | | | | | | | | | - Christopher Biggs
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | | | - Lyn Bennett
- Oxford University Hospital NHS Foundation Trust, UK
| | | | - Andrew Ellis
- Oxford University Hospital NHS Foundation Trust, UK
| | | | - Nathan Smith
- Oxford University Hospital NHS Foundation Trust, UK
| | | | | | - Peter Watkinson
- Oxford University Hospital NHS Foundation Trust, UK,Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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Meephu E, Arwatchananukul S, Aunsri N. Enhancement of Intra-hospital patient transfer in medical center hospital using discrete event system simulation. PLoS One 2023; 18:e0282592. [PMID: 37068093 PMCID: PMC10109477 DOI: 10.1371/journal.pone.0282592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/18/2023] [Indexed: 04/18/2023] Open
Abstract
The intra-hospital transfer of critically ill patients are associated with complications at up to 70%. Numerous issues can be avoided with optimal pre-transport planning and communication. Simulation models have been demonstrated to be an effective method for modeling processes and enhancing on-time service and queue management. Discrete-event simulation (DES) models are acceptable for general hospital systems with increased variability. Herein, they are used to improve service effectiveness. A prospective observational study was conducted on 13 official day patient transfers, resulting in a total of 827 active patient transfers. Patient flow was simulated using discrete-event simulation (DES) to accurately and precisely represent real-world systems and act accordingly. Several patient transfer criteria were examined to create a more realistic simulation of patient flow. Waiting times were also measured to assess the efficiency of the patient transfer process. A simulation was conducted to identify 20 scenarios in order to discover the optimal scenario in which where the number of requests (stretchers or wheelchairs) was increased, while the number of staff was decreased to determine mean waiting times and confidence intervals. The most effective approach for decreasing waiting times involved prioritizing patients with the most severe symptoms. After a transfer process was completed, staff attended to the next transfer process without returning to base. Results show that the average waiting time was reduced by 21.78% which is significantly important for emergency cases. A significant difference was recorded between typical and recommended patient transfer processes when the number of requests increased. To decrease waiting times, the patient transfer procedure should be modified according to our proposed DES model, which can be used to analyze and design queue management systems that achieve optimal waiting times.
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Affiliation(s)
- Ekkarat Meephu
- School of Information Technology, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Nattapol Aunsri
- School of Information Technology, Mae Fah Luang University, Chiang Rai, Thailand
- Computer and Communication Engineering for Capacity Building Research Center (CCC), Mae Fah Luang University, Chiang Rai, Thailand
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Murata M, Nakagawa N, Kawasaki T, Yasuo S, Yoshida T, Ando K, Okamori S, Okada Y. Adverse events during intrahospital transport of critically ill patients: A systematic review and meta-analysis. Am J Emerg Med 2021; 52:13-19. [PMID: 34861515 DOI: 10.1016/j.ajem.2021.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Intrahospital transport of critically ill patients is often necessary for diagnostic procedures, therapeutic procedures, or admission to the intensive care unit. The aim of this study was to investigate and describe safety and adverse events during intrahospital transport of critically ill patients. MATERIAL AND METHODS A systematic search was performed of MEDLINE and the Cochrane Central Register of Controlled Trials for studies published up to June 3, 2020, and of the International Clinical Trials Platform Search Portal and ClinicalTrials.gov for ongoing trials. We selected prospective and retrospective cohort studies published in English on intrahospital transport of critically ill patients, and then performed a meta-analysis. The primary outcome was the incidence of all adverse events that occurred during intrahospital transport. The secondary outcomes were death due to intrahospital transport or life-threatening adverse events, minor events in vital signs, adverse events related to equipment, durations of ICU and hospital stay, and costs. RESULTS A total of 12,313 intrahospital transports and 1898 patients from 24 studies were included in the meta-analysis. Among 24 studies that evaluated the primary outcome, the pooled frequency of all adverse events was 26.2% (95% CI: 15.0-39.2) and the heterogeneity among these studies was high (I2 = 99.5%). The pooled frequency of death due to intrahospital transport and life-threatening adverse events was 0% and 1.47% each, but heterogeneity was also high. CONCLUSIONS Our findings suggest that adverse events can occur during intrahospital transport of critically ill patients, and that the frequency of critical adverse events is relatively low. The results of this meta-analysis could assist in risk-benefit analysis of diagnostic or therapeutic procedures requiring intrahospital transport of critically ill patients. TRIAL REGISTRATION UMIN000040963.
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Affiliation(s)
- Maki Murata
- Department of Emergency Medicine and Critical Care, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Natsuki Nakagawa
- Department of Respiratory Medicine, The University of Tokyo Hospital, Japan.
| | - Takeshi Kawasaki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunsuke Yasuo
- Department of Emergency and Critical Care Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Takuo Yoshida
- Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Ando
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2021; 46:14-22. [PMID: 34802990 DOI: 10.1016/j.medine.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Madrid, Spain.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Medicina, Universidad de Vic-Central de Cataluña, Spain
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Choi K, Keum MA, Kim MS, Kim Y, Choi S, Kyoung KH, Kim JT, Kim S, Noh M. Feasibility of the Ultrasound-Guided Insertion of the Peripherally Inserted Central Catheter (PICC) by the Vascular Surgeon at the Bedside in the Trauma Intensive Care Unit. Ann Vasc Surg 2021; 80:143-151. [PMID: 34688877 DOI: 10.1016/j.avsg.2021.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study analyzed the outcomes of the ultrasound-guided insertion of the peripherally inserted central venous catheter (PICC) by experienced vascular surgeons at the bedside of the trauma intensive care unit (ICU) and compared the outcomes with those of fluoroscopy-guided PICC performed by radiologists in the interventional suite. METHODS Between May 1, 2016, and April 30, 2021, 97 patients who were hospitalized in the trauma ICU and underwent PICC insertion were enrolled in the study. Forty-two out of the 97 patients underwent PICC insertion by interventional radiologists in the interventional radiology suite under fluoroscopy guidance, while the remaining 55 cases underwent ultrasound-guided PICC insertion by the vascular surgeon at the trauma ICU bedside. RESULTS The technical failure (P = 0.504) and malposition (P = 0.127) rates were not significantly different between the 2 groups. However, it took significantly less time for the vascular surgeon to complete the PICC insertion procedure (P < 0.001). Significantly more patients of the ultrasound-guided group required inotropes (P = 0.012) and mechanical ventilation (P = 0.003) at the time of the procedure. In addition, the ultrasound-guided group appeared to be in critical condition in terms of kidney function according to laboratory data (P = 0.014). Meanwhile, the ultrasound-guided group maintained the central line catheter for a shorter time (P < 0.001). CONCLUSIONS In trauma patients, ultrasound-guided PICC insertion at the bedside by experienced vascular surgeons at the trauma ICU was feasible compared to fluoroscopy-guided insertion performed by interventional radiologists.
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Affiliation(s)
- Kyunghak Choi
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Min Ae Keum
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Min Soo Kim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Youngwoong Kim
- Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seongho Choi
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kyu-Hyouck Kyoung
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jihoon T Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sungjeep Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Minsu Noh
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
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Implementation of an Intrahospital Transport Checklist for Emergency Department Admissions to Intensive Care. Pediatr Qual Saf 2021; 6:e426. [PMID: 34235354 PMCID: PMC8225371 DOI: 10.1097/pq9.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/02/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Intrahospital transports (IHTs) are high-risk activities with the potential for adverse outcomes. Suboptimal care of a patient in our emergency department (ED) needing IHT to the pediatric intensive care unit (ICU) identified improvement opportunities. We describe implementing a novel checklist (Briefing ED-to-ICU Transport To Exit Ready: BETTER) for improving the IHT safety of pediatric ED patients admitted to the pediatric ICU. Methods A multidisciplinary team used the Model for Improvement to create a key driver diagram and process map. An evidence-based IHT checklist was implemented on July 23, 2019 after multiple plan-do-study-act checklist revisions. The specific aim was a ≥80% checklist completion rate for 6 months and maintaining that rate for 6 months. An anonymous, voluntary survey of ED nurses and physicians, 9 months postimplementation, evaluated perceived improvements in IHT safety. The outcome measure was the proportion of IHT-related incident reports, per ED-to-pediatric ICU admission, comparing baseline (2-year preimplementation) and intervention (1-year postimplementation) periods. Balancing measures included a quantitative assessment for any throughput measure delays and a survey question on perceived delays. Results From July 23, 2019 to July 22, 2020, 335 (84%) of 400 ED-to-ICU admissions had completed IHT checklists. Ninety percent of survey respondents (84% response rate) agreed that the checklist improved IHT safety. The incident report rate was lower in the intervention period (0.5% versus 2.3%; P = 0.03), with special cause improvement on T-chart analysis. Balancing measures did not indicate any delays secondary to checklist implementation. Conclusions This IHT checklist was feasible and associated with improvements in perceived safety and incident event reporting. Further studies are needed to assess generalizability.
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Haydar B, Baetzel A, Elliott A, MacEachern M, Kamal A, Christensen R. Adverse Events During Intrahospital Transport of Critically Ill Children: A Systematic Review. Anesth Analg 2020; 131:1135-1145. [PMID: 32925334 DOI: 10.1213/ane.0000000000004585] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intrahospital transport of a critically ill patient is often required to achieve a diagnostic and/or therapeutic objective. However, clinicians who recommend a procedure that requires transport are often not fully aware of the risks of transport. Clinicians involved in the care of critically ill children may therefore benefit from a clear enumeration of adverse events that have occurred during transport, risk factors for those events, and guidance for event prevention. The objective of this review was to collect all published harm and adverse events that occurred in critically ill children in the context of transport within a medical center, as well as the incidence of each type of event. A secondary objective was to identify what interventions have been previously studied that reduce events and to collect recommendations for harm prevention from study authors. Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and CINAHL were searched in January 2018 and again in December 2018. Terms indicating pediatric patients, intrahospital transport, critical illness, and adverse events were used. Titles and abstracts were screened and full text was reviewed for any article meeting inclusion criteria. If articles included both children and adults, incidence data were collected only if the number of pediatric patients could be ascertained. Of 471 full-text articles reviewed, 40 met inclusion criteria, of which 24 included only children, totaling 4104 patient transports. Heterogeneity was high, owing to a wide range of populations, settings, data collection methods, and outcomes. The incidence of adverse events varied widely between studies. Examples of harm included emergent tracheostomy, pneumothorax, and cardiac arrest requiring chest compressions. Respiratory and airway events were the most common type of adverse event. Hypothermia was common in infants. One transport-associated death was reported. When causation was assessed, most events were judged to have been preventable or potentially mitigated by improved double-checks and usage of checklists. Prospective studies demonstrated the superiority of mechanical ventilation over manual ventilation for intubated patients. Risk of adverse events during critical care transport appears to relate to the patient's underlying illness and degree of respiratory support. Recommendations for reducing these adverse events have frequently included the use of checklists. Other recommendations include optimization of the patient's physiological status before transport, training with transport equipment, double-checking of equipment before transport, and having experienced clinicians accompany the patient. All available recommendations for reducing transport-associated adverse events in included articles were collated and included.
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Affiliation(s)
- Bishr Haydar
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anne Baetzel
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anila Elliott
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mark MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Afra Kamal
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Robert Christensen
- From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2020; 46:S0210-5691(20)30215-1. [PMID: 32682510 DOI: 10.1016/j.medin.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), MadridEspaña.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Medicina, Universidad de Vic-Central de Cataluña, España
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11
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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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12
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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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13
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Min HJ, Kim HJ, Lee DS, Choi YY, Yoon M, Lee D, Cho JY, Park JS, Cho YJ, Yoon HI, Lee JH, Lee CT, Lee YJ. Intra-hospital transport of critically ill patients with rapid response team and risk factors for cardiopulmonary arrest: A retrospective cohort study. PLoS One 2019; 14:e0213146. [PMID: 30835759 PMCID: PMC6400377 DOI: 10.1371/journal.pone.0213146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/17/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION This study aimed to determine the occurrence rate and risk factors of cardiopulmonary arrest (CPA) during intra-hospital transport (IHT) among critically ill patients, accompanied by a rapid response team (RRT). METHODS We performed a retrospective cohort study in a 1300-bed tertiary-care teaching hospital. Data of all admitted patients transported within the hospital and accompanied by the RRT from October 2012 to May 2016 were included. We compared patients with CPA (+) and patients without CPA (-) to identify risk factors for CPA during transport. RESULTS Among 535 patients, CPA occurred in eight (1.5%) patients during IHT. There were no significant differences in age, sex, and comorbidities between groups. More patients in the CPA (+) group than in the CPA (-) group received manual ventilation during IHT (75% vs. 23.0%, p = 0.001). An increased risk of CPA (p<0.001) corresponded with a higher number of vasopressors used during IHT. In univariate logistic regression analysis, history of myocardial infarction (OR 10.7, 95% CI 2.4-50.5, p = 0.005), manual ventilation (OR 10.1, 95% CI 2.0-50.5, p = 0.005), and use of three or more vasopressors (OR 11.1, 95% CI 2.5-48.9, p = 0.001) were significantly associated with risk of CPA during RRT-led IHT. CONCLUSIONS Despite accompaniment by a specialized team such as the RRT, CPA can occur during IHT. History of myocardial infarction, manual ventilation with bag-valve mask, and the use of three or more vasopressors were independent risk factors of CPA during IHT of critically ill patients accompanied by the RRT.
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Affiliation(s)
- Hyun Ju Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Hyung-Jun Kim
- Department of Internal Medicine, Armed Forces Daegu Hospital, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
| | - Dong Seon Lee
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Yun Young Choi
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Miae Yoon
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Dayoon Lee
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Jun Yeun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- * E-mail:
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14
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Sullivan IW, Hota P, Dako F, Hajdinaj S, Davila B. Dependent layering of venous refluxed contrast: A sign of critically low cardiac output. Radiol Case Rep 2018; 14:230-234. [PMID: 30479677 PMCID: PMC6250913 DOI: 10.1016/j.radcr.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/04/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022] Open
Abstract
Mortality associated with cardiogenic shock can reach 80%. Although most often diagnosed clinically, the hemodynamics of cardiogenic shock may manifest on contrast-enhanced computed tomography as dependent layering of contrast within the inferior vena cava (IVC), a finding referred to as the “IVC level sign.” Herein we present 2 cases of the IVC level sign. Swift recognition of the IVC level sign and awareness of its dire prognostic implications is essential for achieving the best patient outcomes.
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Affiliation(s)
- Ian W Sullivan
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Partha Hota
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Farouk Dako
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Shqiponja Hajdinaj
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Blachy Davila
- Department of Radiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA
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15
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El Nasasra A, Alnsasra H, Zahger D, Lerman TT, Kobal S, Cafri C, Haim M, Fuchs L, Shimony A. Feasibility and safety of exclusive echocardiography-guided intravenous temporary pacemaker implantation. J Echocardiogr 2018; 17:157-161. [PMID: 30426465 DOI: 10.1007/s12574-018-0406-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/07/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The standard approach for urgent trans-venous temporary cardiac pacemaker (TVTP) implantation is fluoroscopy guidance. The delay in activation of the fluoroscopy-room and the transfer of unstable patients may be life-threatening. Echocardiography-guided TP implantation may increase the safety of the patients by obviating the need for in-hospital transfer. We examined the feasibility and safety of echocardiography-guided vs. fluoroscopy-guided TVTP implantation. METHODS From January 2015 to September 2017 data for consecutive patients who needed emergent TVTP implantation were retrospectively reviewed. Ultrasound-guided TVTP protocol that was introduced in our center in January 2015 involved ultrasound guidance for both central venous access and pacing lead positioning. Access sites included femoral, subclavian, or jugular veins. Electrodes were placed in the right ventricular apex by means of echocardiographic monitoring in intensive care unit or by fluoroscopic guidance. Endpoints were achievement of successful ventricular pacing and procedural complications. RESULTS Sixty-six patients (17 echocardiography-guided and 49 fluoroscopy-guided) were included. There were no differences in pacing threshold between the echocardiography-guided group and the fluoroscopy-guided group (0.75 ± 0.58 mA vs. 0.57 ± 0.35 mA, p = 0.24). The access site for implantation was femoral vein in 27% for the fluoroscopy-guided vs. none for the echocardiography-guided approach (p = 0.015). One hematoma and one related infection occurred in the fluoroscopy-guided group. The need for electrode repositioning was observed in 1 patient in each group. There were no procedural-related deaths in either group. CONCLUSIONS Echocardiography-guided temporary cardiac pacing is a feasible and safe alternative to fluoroscopy-guided approach and significantly lowers the need for in-hospital transfer.
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Affiliation(s)
- Aref El Nasasra
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel.
| | - Hilmi Alnsasra
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel
| | - Tsahi T Lerman
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel
| | - Sergio Kobal
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel
| | - Carlos Cafri
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel
| | - Moti Haim
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel
| | - Lior Fuchs
- Department of Internal Medicine, Medical Intensive Care Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Avi Shimony
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer Sheva, Israel
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Kwack WG, Yun M, Lee DS, Min H, Choi YY, Lim SY, Kim Y, Lee SH, Lee YJ, Park JS, Cho YJ. Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team: A cohort study. Medicine (Baltimore) 2018; 97:e13490. [PMID: 30508979 PMCID: PMC6283106 DOI: 10.1097/md.0000000000013490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions.The median age of the 184 subjects included was 72 (inter quartile range, 62-75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 ± 6.0 vs 32.4 ± 7.7, P = .002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P = .001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P = .228).In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.
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Affiliation(s)
- Won Gun Kwack
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Miae Yun
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Dong Seon Lee
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Hyunju Min
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Yun Young Choi
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
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Sather J, Rothenberg C, Finn EB, Sheth KN, Matouk C, Pham L, Parwani V, Ulrich A, Venkatesh AK. Real-Time Surveys Reveal Important Safety Risks During Interhospital Care Transitions for Neurologic Emergencies. Am J Med Qual 2018; 34:53-58. [DOI: 10.1177/1062860618785248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Critically ill patients may be exposed to unique safety threats as a result of the complexity of interhospital and intrahospital transitions involving the emergency department (ED). Real-time surveys were administered to clinicians in the ED and neuroscience intensive care unit of a tertiary health care system to assess perceptions of handoff safety and quality in transitions involving critically ill neurologic patients. In all, 115 clinical surveys were conducted among 26 patient transfers. Among all clinician types, 1 in 5 respondents felt the handoff process was inadequate. Risks to patient safety during the transfer process were reported by 1 in 3 of respondents. Perceived risks were reported more frequently by nurses (44%) than physicians/advanced practice providers (28%). Real-time survey methodology appears to be a feasible and valuable, albeit resource intensive, tool to identify safety risks, expose barriers to communication, and reveal challenges not captured by traditional approaches to inform multidisciplinary quality improvement efforts.
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Affiliation(s)
| | | | | | | | | | - Laura Pham
- Yale School of Medicine, New Haven, CT
- Yale New Haven Hospital, New Haven, CT
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18
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Lotlikar V, Dsouza B, Kamath R, Apuri N. Business Process Re-engineering for Bed Allocation Process in a Tertiary Care Hospital in Mumbai. JOURNAL OF HEALTH MANAGEMENT 2018. [DOI: 10.1177/0972063418763649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A proficient bed allotment system in the hospital reflects effective management. Minimizing the waiting time and appropriate bed allocation ensures quality of care and optimum utilization of hospital resources. The hospital management must respond to the growing needs of the patient care by reducing the admission delays and communication delays among health care providers. The objective of the study was to understand the bed allocation process, to evaluate reasons for delay in bed allotment and to minimize the waiting time for new admissions in a 750-bedded tertiary care hospital. The study was conducted by taking a random sample of 35 beds of general category. The admission time was recorded through hospital information system and by interviewing the nursing and housekeeping staff. The study revealed that the delay in communication from nurse station to admission counter was the major reason followed by delay in billing process and delay in preparing bed by the housekeeping staff.
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Affiliation(s)
- Vrunda Lotlikar
- Student Trainee, Hospital Administration Program, Department of Public Health, Manipal University, Manipal, Karnataka, India
| | - Bryal Dsouza
- Assistant Professor, MHA Program, Department of Public Health, Manipal University, Manipal, Karnataka, India
| | - Rajesh Kamath
- Assistant Professor, MHA Program, Department of Public Health, Manipal University, Manipal, Karnataka, India
| | - Nikitha Apuri
- Student Trainee, Hospital Administration Program, Department of Public Health, Manipal University, Manipal, Karnataka, India
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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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20
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Chaikittisilpa N, Lele AV, Lyons VH, Nair BG, Newman SF, Blissitt PA, Vavilala MS. Risks of Routinely Clamping External Ventricular Drains for Intrahospital Transport in Neurocritically Ill Cerebrovascular Patients. Neurocrit Care 2017; 26:196-204. [PMID: 27757914 DOI: 10.1007/s12028-016-0308-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current guidelines recommend routine clamping of external ventricular drains (EVD) for intrahospital transport (IHT). The aim of this project was to describe intracranial hemodynamic complications associated with routine EVD clamping for IHT in neurocritically ill cerebrovascular patients. METHODS We conducted a retrospective review of cerebrovascular adult patients with indwelling EVD admitted to the neurocritical care unit (NICU) during the months of September to December 2015 at a tertiary care center. All IHTs from the NICU of the included patients were examined. Main outcomes were incidence and risk factors for an alteration in intracranial pressure (ICP) and cerebral perfusion pressure after IHT. RESULTS Nineteen cerebrovascular patients underwent 178 IHTs (79.8 % diagnostic and 20.2 % therapeutic) with clamped EVD. Twenty-one IHTs (11.8 %) were associated with post-IHT ICP ≥ 20 mmHg, and 33 IHTs (18.5 %) were associated with escalation of ICP category. Forty IHTs (26.7 %) in patients with open EVD status in the NICU prior to IHT were associated with IHT complications, whereas no IHT complications occurred in IHTs with clamped EVD status in the NICU. Risk factors for post-IHT ICP ≥ 20 mmHg were IHT for therapeutic procedures (adjusted relative risk [aRR] 5.82; 95 % CI, 1.76-19.19), pre-IHT ICP 15-19 mmHg (aRR 3.40; 95 % CI, 1.08-10.76), pre-IHT ICP ≥ 20 mmHg (aRR 12.94; 95 % CI, 4.08-41.01), and each 1 mL of hourly cerebrospinal fluid (CSF) drained prior to IHT (aRR 1.11; 95 % CI, 1.01-1.23). CONCLUSIONS Routine clamping of EVD for IHT in cerebrovascular patients is associated with post-IHT ICP complications. Pre-IHT ICP ≥ 15 mmHg, increasing hourly CSF output, and IHT for therapeutic procedures are risk factors.
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Affiliation(s)
- Nophanan Chaikittisilpa
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
| | - Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Vivian H Lyons
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Bala G Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Shu-Fang Newman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Patricia A Blissitt
- Harborview Medical Center, University of Washington School of Nursing, Seattle, WA, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA
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21
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Abstract
OBJECTIVE To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. DESIGN A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. SETTING The study was undertaken at two ICUs in one university hospital. PATIENTS Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4-10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. CONCLUSIONS Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
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Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan. Dimens Crit Care Nurs 2017; 35:133-46. [PMID: 27043399 DOI: 10.1097/dcc.0000000000000176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intrahospital transport of the critically ill adult carries inherent risks that can be manifested as unexpected events. OBJECTIVE The aim of this study is to evaluate the implementation of a standardized evaluation plan for intrahospital transports to/from adult intensive care units. METHODS Nurses at a level I trauma/academic center captured clinical data throughout transport. Outcome measures included compliance with the organization's transport policy and unexpected events. RESULTS There were 502 transports audited. Most nurses were compliant with the policy, except for the stabilization process (n = 174, 34.7%). Forty-one transports (8.2%) had an unexpected event, and 11 of these transports (26.8%) were aborted. Most of the events were hemodynamic (12), sedation (11), respiratory (10), and gastrointestinal (5). Fewer events occurred with the transport team (P = .036) and among nurses with a bachelor of science in nursing or higher degree (P = .002). Events were higher among transporting nurses with only 0 to 2 years of intensive care unit experience (P = .002), "stabilized" transports (P = .022), and patients with higher Acute Physiology and Chronic Health Evaluation scores (P = .009). CONCLUSIONS Health care organizations should have a policy that includes both transport and evaluation plans for intrahospital transport. Guidelines should be revised with specific criteria for the stabilization process and unexpected events. Revision should also have a standardized evaluation plan that includes an audit tool to measure incidence of unexpected events and a rapid change quality improvement method.
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Harish MM, Janarthanan S, Siddiqui SS, Chaudhary HK, Prabu NR, Divatia JV, Kulkarni AP. Complications and benefits of intrahospital transport of adult Intensive Care Unit patients. Indian J Crit Care Med 2016; 20:448-52. [PMID: 27630455 PMCID: PMC4994123 DOI: 10.4103/0972-5229.188190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: The transport of critically ill patients for procedures or tests outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. Plenty of data is available on pre- and inter-hospital transport of patients; the data on intrahospital transport of patients are limited. We audited the complications and benefits of intrahospital transport of critically ill patients in our tertiary care center over 6 months. Materials and Methods: One hundred and twenty adult critically ill cancer patients transported from the ICU for either diagnostic or therapeutic procedure over 6 months were included. The data collected include the destination, the accompanying person, total time spent outside the ICU, and any adverse events and adverse change in vitals. Results: Among the 120 adult patients, 5 (4.1%) required endotracheal intubation, 5 (4.1%) required intercostal drain placement, and 20 (16.7%) required cardiopulmonary resuscitation (CPR). Dislodgement of central venous catheter occurred in 2 (1.6%) patients, drain came out in 3 (2.5%) patients, orogastric tube came out in 1 (0.8%) patient, 2 (1.6%) patients self-extubated, and in one patient, tracheostomy tube was dislodged. The adverse events were more in patients who spent more than 60 min outside the ICU, particularly requirement of CPR (18 [25%] vs. 2 [4.2%], ≤60 min vs. >60 min, respectively) with P < 0.05. Transport led to change in therapy in 32 (26.7%) patients. Conclusion: Transport in critically ill cancer patients is more hazardous and needs adequate pretransport preparations. Transport in spite being hazardous may lead to a beneficial change in therapy in a significant number of patients.
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Affiliation(s)
- M M Harish
- Department of Anesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Janarthanan
- Department of Anesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suhail Sarwar Siddiqui
- Department of Anesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Harish K Chaudhary
- Department of Anesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Natesh R Prabu
- Department of Anesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Department of Anesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Knight PH, Maheshwari N, Hussain J, Scholl M, Hughes M, Papadimos TJ, Guo WA, Cipolla J, Stawicki SP, Latchana N. Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention. Int J Crit Illn Inj Sci 2016; 5:256-64. [PMID: 26807395 PMCID: PMC4705572 DOI: 10.4103/2229-5151.170840] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intrahospital transportation of critically ill patients is associated with significant complications. In order to reduce overall risk to the patient, such transports should well organized, efficient, and accompanied by the proper monitoring, equipment, and personnel. Protocols and guidelines for patient transfers should be utilized universally across all healthcare facilities. Care delivered during transport and at the site of diagnostic testing or procedure should be equivalent to the level of care provided in the originating environment. Here we review the most common problems encountered during transport in the hospital setting, including various associated adverse outcomes. Our objective is to make medical practitioners, nurses, and ancillary health care personnel more aware of the potential for various complications that may occur during patient movement from the intensive care unit to other locations within a healthcare facility, focusing on risk reduction and preventive strategies.
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Affiliation(s)
- Patrick H Knight
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Neelabh Maheshwari
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Jafar Hussain
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Michael Scholl
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Michael Hughes
- Temple University School of Medicine - St. Luke's University Hospital Campus, Bethlehem, Pennsylvania, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Weidun Alan Guo
- Department of Surgery, Division of Trauma, Critical Care and Acute Care Surgery, The State University of New York (SUNY)-University at Buffalo, Buffalo, New York, USA
| | - James Cipolla
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Nicholas Latchana
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Jia L, Wang H, Gao Y, Liu H, Yu K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Crit Care 2016; 20:12. [PMID: 26781179 PMCID: PMC4717618 DOI: 10.1186/s13054-016-1183-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/06/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the incidence of adverse events (AEs) during intra-hospital transport (IHT) of critically ill patients and evaluate the risk factors associated with these events. METHODS This prospective multicenter observational study was performed in 34 intensive care units in China during 20 consecutive days from 5 November to 25 November 2012. All consecutive patients who required IHT for diagnostic testing or therapeutic procedures during the study period were included. All AEs that occurred during IHT were recorded. The incidence of AEs was defined as the rate of transports with at least one AE. The statistical analysis included a description of demographic and clinical characteristics of the cohort as well as identification of risk factors for AEs during IHT by univariate and multivariate logistic regression analyses. RESULTS In total, 441 IHTs of 369 critically ill patients were analyzed. The overall incidence of AEs was 79.8% (352 IHTs). The proportion of equipment- and staff-related adverse events was 7.9% (35 IHTs). The rate of patient-related adverse events (P-AEs) was 79.4% (349 IHTs). The rates of vital sign-related P-AEs and arterial blood gas analysis-related P-AEs were 57.1% (252 IHTs) and 46.9% (207 IHTs), respectively. The incidence of critical P-AEs was 33.1% (146 IHTs). The rates of vital sign-related critical P-AEs and arterial blood gas analysis-related critical P-AEs were 22.9% (101 IHTs) and 15.0% (66 IHTs), respectively. All data collected in our study were considered potential risk factors. In the multivariate analysis, predictive factors for P-AEs were pH, partial pressure of carbon dioxide in arterial blood, lactate level, glucose level, and heart rate before IHT. Furthermore, the Acute Physiology and Chronic Health Evaluation II score, partial pressure of oxygen in arterial blood, lactate level, glucose level, heart rate, respiratory rate, pulse oximetry, and sedation before transport were independent influential factors for critical P-AEs during IHT. CONCLUSIONS The incidence of P-AEs during IHT of critically ill patients was high. Risk factors for P-AEs during IHT were identified. Strategies are needed to reduce their frequency. TRIAL REGISTRATION Chinese Clinical Trial Register identifier ChiCTR-OCS-12002661. Registered 5 November 2012.
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Affiliation(s)
- Liu Jia
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yang Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Haitao Liu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Kaijiang Yu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Taggu A, Murthy S, Krishna B, Varma MKM. Mishaps during intrahospital transport of patients from emergency department - a mixed bag of patients. Intensive Care Med Exp 2015. [PMCID: PMC4796483 DOI: 10.1186/2197-425x-3-s1-a69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care. BIOMED RESEARCH INTERNATIONAL 2015; 2015:868653. [PMID: 26558286 PMCID: PMC4629003 DOI: 10.1155/2015/868653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/16/2015] [Accepted: 07/26/2015] [Indexed: 12/03/2022]
Abstract
The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.
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Wise MP, Barnes RA, Baudouin SV, Howell D, Lyttelton M, Marks DI, Morris EC, Parry-Jones N. Guidelines on the management and admission to intensive care of critically ill adult patients with haematological malignancy in the UK. Br J Haematol 2015; 171:179-188. [PMID: 26287443 DOI: 10.1111/bjh.13594] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Matt P Wise
- Cardiff University and University of Wales Hospital Cardiff, Cardiff, UK
| | | | - Simon V Baudouin
- Royal Victoria Infirmary and Newcastle University, Newcastle upon Tyne, UK
| | - David Howell
- University College London NHS Foundation Trust, London, UK
| | | | - David I Marks
- University Hospitals of Bristol NHS Trust, Bristol, UK
| | - Emma C Morris
- University College London, Royal Free Hospital, London, UK
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Matsumura Y, Nakada TA, Hayashi Y, Oshima T, Oda S. Intrahospital transport of mechanically ventilated intensive care patients using new equipment attached to a transfer board. Acute Med Surg 2015; 2:219-222. [PMID: 29123726 DOI: 10.1002/ams2.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/24/2014] [Indexed: 11/10/2022] Open
Abstract
Aim Multiple lines and tubes often complicate bed transfer in critically ill patients. To solve this problem, the authors developed medical equipment attached to a transfer board ("transfer board tree") that integrates the patient, transfer board, and medical equipment. The objective of this study was to evaluate the efficiency and safety of the transfer board tree. Methods Forty mechanically ventilated patients (20 transfer board tree, 20 conventional) in the intensive care unit who were transported for computed tomography were enrolled. Transfer times and adverse events were recorded. Results Transfer board tree patients had significantly shorter transfer times. There were two adverse events only in the conventional group. Conclusions The transfer board tree enables rapid intrahospital transport of intensive care patients with sufficient monitoring.
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Affiliation(s)
- Yosuke Matsumura
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Yosuke Hayashi
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine Chiba Japan
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Transferring the critically ill patient: are we there yet? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:62. [PMID: 25887575 PMCID: PMC4335540 DOI: 10.1186/s13054-015-0749-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
During the past few decades the numbers of ICUs and beds has increased significantly, but so too has the demand for intensive care. Currently large, and increasing, numbers of critically ill patients require transfer between critical care units. Inter-unit transfer poses significant risks to critically ill patients, particularly those requiring multiple organ support. While the safety and quality of inter-unit and hospital transfers appear to have improved over the years, the effectiveness of specific measures to improve safety have not been confirmed by randomized controlled trials. It is generally accepted that critically ill patients should be transferred by specialized retrieval teams, but the composition, training and assessment of these teams is still a matter of debate. Since it is likely that the numbers and complexity of these transfers will increase in the near future, further studies are warranted.
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Spain D, Crilly J, Pierce J, Steele M, Scuffham P, Keijzers G. Can a barcode scanner for blood collection improve patient identification integrity in the emergency department? A prospective before‐and‐after study. Emerg Med Australas 2015; 27:47-54. [DOI: 10.1111/1742-6723.12334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- David Spain
- Department of Emergency Medicine Gold Coast Hospital and Health Service Gold Coast Queensland Australia
- School of Medicine Griffith University Gold Coast Queensland Australia
| | - Julia Crilly
- Department of Emergency Medicine Gold Coast Hospital and Health Service Gold Coast Queensland Australia
- Centre for Health Practice Innovation Griffith Health Institute Griffith University Gold Coast Queensland Australia
| | - John Pierce
- Department of Emergency Medicine Gold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Michael Steele
- Faculty of Science Universiti Brunei Darussalam Gadong Brunei
- Griffith Graduate Research School Griffith University Gold Coast Queensland Australia
| | - Paul Scuffham
- School of Medicine Griffith Health Institute Griffith University Gold Coast Queensland Australia
| | - Gerben Keijzers
- Department of Emergency Medicine Gold Coast Hospital and Health Service Gold Coast Queensland Australia
- School of Medicine Bond University Gold Coast Queensland Australia
- Griffith Health Institute Griffith University Gold Coast Queensland Australia
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Abstract
OBJECTIVES Children must often be transported to dedicated pediatric centers to receive specialized medical and surgical care, which places them at risk for significant deterioration and life-threatening events. Studies designed to identify and mitigate these events have been limited by variability in the selection and definition of significant events. The objective of this study was to identify and evaluate indicators that represent significant events during the transport of pediatric patients and are relevant to future research initiatives in transport medicine. DESIGN We conducted a modified Delphi study consisting of four iterations. SETTING The expert panel included Canadian, interdisciplinary healthcare providers with transport experience. INTERVENTIONS In the first Delphi iteration, experts suggested indicators for consideration and evaluated proposed indicators from the literature and introduced by the study steering committee. In subsequent iterations, respondents reevaluated all indicators that had not yet achieved a priori-defined consensus; group comments and aggregate scores for each indicator from previous iterations were provided. MEASUREMENTS AND MAIN RESULTS The expert panel consisted of 16 physicians and 17 nonphysician healthcare providers from 10 Canadian institutions. In total, the panel evaluated 57 indicators, including 26 not previously presented in the literature. The expert panel determined 52 were significant and relevant to future studies in pediatric transport. The final indicator list includes trigger tools (interventions, physiological markers, and laboratory values) and team member safety and process issues. CONCLUSIONS Using a systematic, modified Delphi approach, we developed an inclusive list of indicators for application to pediatric transport-related quality improvement and clinical research projects.
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Wang C, Savkin AV, Clout R, Nguyen HT. An Intelligent Robotic Hospital Bed for Safe Transportation of Critical Neurosurgery Patients Along Crowded Hospital Corridors. IEEE Trans Neural Syst Rehabil Eng 2014; 23:744-54. [PMID: 25137731 DOI: 10.1109/tnsre.2014.2347377] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present a novel design of an intelligent robotic hospital bed, named Flexbed, with autonomous navigation ability. The robotic bed is developed for fast and safe transportation of critical neurosurgery patients without changing beds. Flexbed is more efficient and safe during the transportation process comparing to the conventional hospital beds. Flexbed is able to avoid en-route obstacles with an efficient easy-to-implement collision avoidance strategy when an obstacle is nearby and to move towards its destination at maximum speed when there is no threat of collision. We present extensive simulation results of navigation of Flexbed in the crowded hospital corridor environments with moving obstacles. Moreover, results of experiments with Flexbed in the real world scenarios are also presented and discussed.
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Venkategowda PM, Rao SM, Mutkule DP, Taggu AN. Unexpected events occurring during the intra-hospital transport of critically ill ICU patients. Indian J Crit Care Med 2014; 18:354-7. [PMID: 24987233 PMCID: PMC4071678 DOI: 10.4103/0972-5229.133880] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Intra-hospital transport of critically ill patients is a challenging task. However, despite the improvements in intra-hospital transport practices, adverse event incidents remain high and constitute a significant risk for the transport of the critically ill ICU patients. Objectives: To observe the number and types of unexpected-events (UEs) occurring during intra-hospital transport of critically ill ICU patients. Interventions provided along with outcome. Materials and Methods: This was a prospective observational study of 254 intra-hospital critically-ill ICU patients of our hospital transported for diagnostic purposes during April 2012 - March 2013. The escorting intensivist completed the data of unexpected events during transport. Results: A total of 254 patients were observed prospectively for UEs during intra-hospital transfer of critically ill patients. The overall UEs observed were 139 among 64 patients. Among the UEs which occurred, the maximum were miscellaneous causes [89 (64.00%)] like oxygen probe [38 (27.33%)] or ECG lead displacement [27 (19.42%)]. Major events like fall in spo2 >5% observed in 15 (10.79%) patients, BP variation > 20% from baseline in 22 (15.82%) patients, altered mental status in 5 (3.59%), and arrhythmias in 6 (4.31%) patients. Among 64 (100%) patients with UEs, 3 (2.15%) patients with serious adverse events have been aborted from transport. Conclusion: Unexpected-events (UEs) are common during transport of critically ill ICU patients and these adverse events can be reduced when critically ill patients are accompanied by intensivist/medically qualified person during transport and following strict transport guidelines.
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Affiliation(s)
- Pradeep M Venkategowda
- Departments of Critical Care Medicine, Yashoda Hospital, Hyderabad, Andhra Pradesh, India
| | - Surath M Rao
- Departments of Critical Care Medicine, Yashoda Hospital, Hyderabad, Andhra Pradesh, India
| | - Dnyaneshwar P Mutkule
- Departments of Critical Care Medicine, Yashoda Hospital, Hyderabad, Andhra Pradesh, India
| | - Alai N Taggu
- Departments of Critical Care Medicine, Yashoda Hospital, Hyderabad, Andhra Pradesh, India
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Brenner M, Hilliard C, Regan G, Coughlan B, Hayden S, Drennan J, Kelleher D. Research priorities for children's nursing in Ireland: a Delphi study. J Pediatr Nurs 2014; 29:301-8. [PMID: 24486031 DOI: 10.1016/j.pedn.2014.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 11/29/2022]
Abstract
This paper is a report of a study which identified research priorities for children's nursing in an acute care setting in Ireland. A limited number of studies have examined research priorities for children's nursing. This study was undertaken against the backdrop of significant proposed changes to the delivery of children's healthcare. A three round Delphi survey design was used to identify and rate the importance of research priorities for children's nursing. In round I participants were asked to identify five of the most important research priorities for children's nursing. Participants in round II were asked to rate the importance of each research priority on a 7-point Likert scale. In round III participants were presented with the mean score of each research priority from the second questionnaire, and again asked to consider the importance of each topic on a 7-point Likert scale. The aim was to reach consensus on the priorities. The top three priorities identified were recognition and care of the deteriorating child, safe transfer of the critically ill child between acute health care facilities, and the child and family's perceptions of care at end-of life. The wide variation of priorities reflects the scope of care delivery of children's nurses and mirrors many global care concerns in caring for children.
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Affiliation(s)
- Maria Brenner
- School of Nursing, Midwifery & Health Systems, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Carol Hilliard
- Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | | | - Barbara Coughlan
- School of Nursing, Midwifery & Health Systems, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
| | - Sharon Hayden
- Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Jonathan Drennan
- Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO171BJ
| | - Deirdre Kelleher
- School of Nursing, Midwifery & Health Systems, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
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Oscier C, Emerson B, Handy JM. New perspectives on airway management in acutely burned patients. Anaesthesia 2014; 69:105-10. [DOI: 10.1111/anae.12565] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Oscier
- Chelsea and Westminster NHS Foundation Trust; London UK
| | - B. Emerson
- St Andrews Centre for Plastic Surgery and Burns; Mid Essex Hospitals NHS Trust; Chelmsford UK
| | - J. M. Handy
- Chelsea and Westminster NHS Foundation Trust; London UK
- Imperial College London; London UK
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Picetti E, Antonini MV, Lucchetti MC, Pucciarelli S, Valente A, Rossi I, Schiavi P, Servadei F, Caspani ML, Mergoni M. Intra-hospital transport of brain-injured patients: a prospective, observational study. Neurocrit Care 2014. [PMID: 23208448 DOI: 10.1007/s12028-012-9802-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Discrepant data exist regarding the incidence and severity of clinical problems related to intra-hospital transport of brain-injured patients and no consensus exists whether modern-day intra-hospital transport represents a safe or potentially problematic environment for neurointensive care unit (NICU) patients. METHODS We examined the incidence of clinical complications and physiological derangements that occurred in 160 neurologically injured patients (90 males, 70 females, mean age 57 ± 17 years) who underwent intra-hospital transport (288 cases, 237 scheduled, 51 unscheduled) for computed tomography scans. RESULTS Our findings indicate that (1) at least one significant complication (predominantly hemodynamic) occurred in over one-third (36%) of all transports (p = n.s scheduled vs. unscheduled) necessitating the deployment of interventions designed to treat changes in arterial pressure (2) despite the presence of trained medical personnel and availability of specialized equipment, intra-cranial pressure was not adequately monitored during transports (especially in patients with intra-cranial hypertension prior to transport) (3) intra-hospital transfer was associated with minor but statistically significant clinical changes, including a reduction in arterial partial pressure of oxygen (Pa(O(2)))/inspired oxygen fraction (Fi(O(2))) (only in the scheduled transport population), decreased arterial lactate levels (scheduled transport population), lowered body temperature (scheduled transport population), and increased arterial partial pressure of carbon dioxide (Pa(CO(2))) (scheduled transport population). CONCLUSIONS Intra-hospital transport of brain-injured NICU patients may present some hazards even if performed by skilled personnel with specialized equipment. In Trauma Centers such as ours, an improvement in the frequency of neuromonitoring [intra-cranial pressure (ICP) and end-tidal CO2 (ET(CO(2)))] during transport is recommended.
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Affiliation(s)
- Edoardo Picetti
- I Servizio Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100 Parma, Italy.
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Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study*. Crit Care Med 2013; 41:1919-28. [PMID: 23863225 DOI: 10.1097/ccm.0b013e31828a3bbd] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To describe intrahospital transport complications in critically ill patients receiving invasive mechanical ventilation. DESIGN Prospective multicenter cohort study. SETTING Twelve French ICUs belonging to the OUTCOMEREA study group. PATIENTS Patients older than or equal to 18 years old admitted in the ICU and requiring invasive mechanical ventilation between April 2000 and November 2010 were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Six thousand two hundred forty-two patients on invasive mechanical ventilation were identified in the OUTCOMEREA database. The statistical analysis included a description of demographic and clinical characteristics of the cohort, identification of risk factors for intrahospital transport and construction of an intrahospital transport propensity score, and an exposed/unexposed study to compare complication of intrahospital transport (excluding transport to the operating room) after adjustment on the propensity score, length of stay, and confounding factors on the day before intrahospital transport. Three thousand and six intrahospital transports occurred in 1,782 patients (28.6%) (1-17 intrahospital transports/patient). Transported patients had higher admission Simplified Acute Physiology Score II values (median [interquartile range], 51 [39-65] vs 46 [33-62], p < 10) and longer ICU stay lengths (12 [6-23] vs 5 [3-11] d, p < 10). Post-intrahospital transport complications were recorded in 621 patients (37.4%). We matched 1,659 intrahospital transport patients to 3,344 nonintrahospital transport patients according to the intrahospital transport propensity score and previous ICU stay length. After adjustment, intrahospital transport patients were at higher risk for various complications (odds ratio = 1.9; 95% CI, 1.7-2.2; p < 10), including pneumothorax, atelectasis, ventilator-associated pneumonia, hypoglycemia, hyperglycemia, and hypernatremia. Intrahospital transport was associated with a longer ICU length of stay but had no significant impact on mortality. CONCLUSIONS Intrahospital transport increases the risk of complications in ventilated critically ill patients. Continuous quality improvement programs should include specific procedures to minimize intrahospital transport-related risks.
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Parmentier-Decrucq E, Poissy J, Favory R, Nseir S, Onimus T, Guerry MJ, Durocher A, Mathieu D. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care 2013; 3:10. [PMID: 23587445 PMCID: PMC3639083 DOI: 10.1186/2110-5820-3-10] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 03/07/2013] [Indexed: 01/03/2023] Open
Abstract
Background Transport of critically ill patients for diagnostic or therapeutic procedures is at risk of complications. Adverse events during transport are common and may have significant consequences for the patient. The objective of the study was to collect prospectively adverse events that occurred during intrahospital transports of critically ill patients and to determine their risk factors. Methods This prospective, observational study of intrahospital transport of consecutively admitted patients with mechanical ventilation was conducted in a 38-bed intensive care unit in a university hospital from May 2009 to March 2010. Results Of 262 transports observed (184 patients), 120 (45.8%) were associated with adverse events. Risk factors were ventilation with positive end-expiratory pressure >6 cmH2O, sedation before transport, and fluid loading for intrahospital transports. Within these intrahospital transports with adverse events, 68 (26% of all intrahospital transports) were associated with an adverse event affecting the patient. Identified risk factors were: positive end-expiratory pressure >6 cmH2O, and treatment modification before transport. In 44 cases (16.8% of all intrahospital transports), adverse event was considered serious for the patient. In our study, adverse events did not statistically increase ventilator-associated pneumonia, time spent on mechanical ventilation, or length of stay in the intensive care unit. Conclusions This study confirms that the intrahospital transports of critically ill patients leads to a significant number of adverse events. Although in our study adverse events have not had major consequences on the patient stay, efforts should be made to decrease their incidence.
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Affiliation(s)
- Erika Parmentier-Decrucq
- Service d'Urgence Respiratoire, Réanimation Médicale et Medecine Hyperbare, Université de Lille II et Centre Hospitalier et Universitaire de Lille, Lille 59037, France.
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Abstract
OBJECTIVE Interhospital transfer of critically ill patients is a common part of their care. This article sought to review the data on the current patterns of use of interhospital transfer and identify systematic barriers to optimal integration of transfer as a mechanism for improving patient outcomes and value of care. DATA SOURCE Narrative review of medical and organizational literature. SUMMARY Interhospital transfer of patients is common, but not optimized to improve patient outcomes. Although there is a wide variability in quality among hospitals of nominally the same capability, patients are not consistently transferred to the highest quality nearby hospital. Instead, transfer destinations are selected by organizational routines or non-patient-centered organizational priorities. Accomplishing a transfer is often quite difficult for sending hospitals. But once a transfer destination is successfully found, the mechanics of interhospital transfer now appear quite safe. CONCLUSION Important technological advances now make it possible to identify nearby hospitals best able to help critically ill patients, and to successfully transfer patients to those hospitals. However, organizational structures have not yet developed to insure that patients are optimally routed, resulting in potentially significant excess mortality.
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Barratt H. Critical Care Transfer Quality 2000–2009: Systematic Review to Inform the ICS Guidelines for Transport of the Critically Ill Adult (3rd ed). J Intensive Care Soc 2012. [DOI: 10.1177/175114371201300409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper describes the findings of a systematic literature review that was undertaken to inform the third edition of the Intensive Care Society's (ICS) Guidelines for the Transport of the Critically Ill Adult, which has recently been published. Thirty-eight articles were identified relating to the process of adult patient transfer. The bulk of the articles related to transfer quality, including review articles and audits assessing both the standard of transfers and compliance with relevant guidelines. The review demonstrates that the quality of transfers remains a concern, but much of the data is from single centre audits and case series, which are thought to provide the weakest level of evidence. The guidelines have been extensively updated to reflect both current practice and emerging evidence, but it is clear that measures are still needed to improve the quality of transfers.
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Affiliation(s)
- Helen Barratt
- Research Training Fellow, Department of Applied Health Research, University College London
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Bérubé M, Bernard F, Marion H, Parent J, Thibault M, Williamson DR, Albert M. Impact of a preventive programme on the occurrence of incidents during the transport of critically ill patients. Intensive Crit Care Nurs 2012; 29:9-19. [PMID: 22921453 DOI: 10.1016/j.iccn.2012.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 07/02/2012] [Accepted: 07/07/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Incidents related to transport of critically ill patients have been extensively reported. The objective of this study was to determine the effect of an interdisciplinary preventive programme used by all intensive care unit team members involved in patients' transport on the rate of these incidents. METHODS A clinical quality improvement audit using a prospective pre and post intervention design was performed among medical and surgical patients hospitalised in intensive care who required intra or inter-hospital transport. RESULTS A total of 180 transports occurred in the pre-implementation phase of the study and 187 transports in the post-implementation phase. A 20% absolute reduction of incidents was observed (57.2% vs. 37.4%, p<0.001). Statistically significant reductions were obtained for the technical problems category of incidents (25% vs. 7.5%, p<0.001) as well as the problems related to patient's mobilisation category (14.4% vs. 7.5%, p=0.05). Clinically significant trends were also observed for the clinical deterioration (24.4% vs. 17.1%, p=0.11) and undesired delay before test (23.9% vs. 17.6%, p=0.14) categories but did not reach statistical significance. CONCLUSIONS A preventive programme applied by all care providers involved in transport of critically ill patients was associated with a reduction of incidents. The application of such a programme should be acknowledged as a standard of care considering the risks inherent to the transportation of ICU patients.
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Affiliation(s)
- M Bérubé
- Intensive Care Unit, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
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Fehlerentstehung und Fehlerprävention auf Intensivstationen. Med Klin Intensivmed Notfmed 2012; 107:244-8. [DOI: 10.1007/s00063-011-0059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 03/12/2012] [Indexed: 11/27/2022]
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Guided transfer of critically ill patients: where patients are transferred can be an informed choice. Curr Opin Crit Care 2012; 17:641-7. [PMID: 21897217 DOI: 10.1097/mcc.0b013e32834b3e55] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Given increasingly scarce healthcare resources and highly differentiated hospitals, with growing demand for critical care, interhospital transfer is an essential part of the care of many patients. The purpose of this review is to examine the extent to which hospital quality is considered when transferring critically ill patients, and to examine the potential benefits to patients of a strategy that incorporates objective quality data into referral patterns. RECENT FINDINGS Interhospital transfer of critically ill patients is now common and safe. Although extensive research has focused on which patients should be transferred and when they should be transferred, recent study has focused on where patients should be transferred. Yet, the choice of destination hospital is rarely recognized as a therapeutic choice with implications for patient outcomes. The recent public release of high-quality, risk-adjusted and reliability-adjusted outcome data for most hospitals now offers physicians an informed basis on which to choose to which destination hospital a patient should be transferred. A strategy of 'guided transfer' that integrates public quality information into critical care transfer decisions is now feasible. SUMMARY Although hospitals often transfer patients, there may be substantial room for improvement in transfer patterns. Guiding transfers on the basis of objective quality information may offer substantial benefits to patients, and could be incorporated into quality improvement initiatives.
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Ong MS, Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf 2011; 37:274-84. [PMID: 21706987 DOI: 10.1016/s1553-7250(11)37035-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Handoffs serve a critical function in ensuring patient care continuity during transitions of care. Studies to date have predominantly focused on intershift handoffs, with relatively little attention given to intrahospital transfers. A systematic literature review was conducted to characterize the nature of handoff failures during intrahospital transfers and to examine factors affecting handoff communication and the effectiveness of current interventions. METHODS Primary studies investigating handoff communication between care providers during intrahospital transfers were sought in the English-language literature between 1980 and February 2011. Data for study design, population characteristics, sample size, setting, intervention specifics, and relevant outcome measures were extracted. DATA SYNTHESIS Study results were summarized by the impact of communication breakdown during intrahospital transfer of patients, and the current deficiencies in the process. Results of interventions were summarized by their effect on the quality of handoff communication and patient safety. FINDINGS The initial search identified 516 individual articles, 24 of which satisfied the inclusion criteria. Some 19 were primary studies on handoff practices and deficiencies, and the remaining 5 were interventional studies. The studies were categorized according to the clinical settings involved in the intrahospital patient transfers. CONCLUSIONS There is consistent evidence on the perceived impact of communication breakdown on patient safety during intrahospital transfers. Exposure of handoffs at patient transfers presents challenges that are not experienced in intershift handoffs. The distinct needs of the specific clinical settings involved in the intrahospital patient transfer must be considered when deciding on suitable interventions.
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Affiliation(s)
- Mei-Sing Ong
- Centre for Health Informatics, University of New South Wales, Sydney, Australia.
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Noa Hernández J, González EC, Romero JC, Baños LCD. Transporte intrahospitalario del paciente grave. Necesidad de una guía de actuación. ENFERMERIA INTENSIVA 2011; 22:74-7. [DOI: 10.1016/j.enfi.2010.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 08/31/2010] [Indexed: 11/27/2022]
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Salottolo KM, Fanale CV, Leonard KA, Frei DF, Bar-Or D. Multimodal imaging does not delay intravenous thrombolytic therapy in acute stroke. AJNR Am J Neuroradiol 2011; 32:864-8. [PMID: 21310859 DOI: 10.3174/ajnr.a2394] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Patients with acute ischemic stroke require immediate medical treatment, and a CT to rule out hemorrhage is required before tPA. We adapted our protocol to include multimodal CT: unenhanced CT, CTA, and PCT. The purpose of this study was to determine whether multimodal CT imaging delays initiation of IV tPA beyond 60 minutes from hospital arrival. MATERIALS AND METHODS All patients admitted during 3 years through the ED with a stroke alert and time from symptom onset to hospital arrival <2.5 hours were included. We examined 2 subgroups (multimodal CT versus unenhanced CT) to determine whether multimodal CT delayed tPA administration. Logistic regression was used to identify variables that predicted tPA within 60 minutes. RESULTS There were 123 patients in the analysis, including 108 patients who were examined with multimodal CT. The median time from arrival to tPA was 56 minutes and was shorter for patients examined with multimodal CT (55 versus 78 minutes, P = .02). After adjustment, variables that were associated with tPA administration within 60 minutes included prehospital stroke alert (OR = 3.47, P = .03), time to CT (OR = 0.94, P = .01), and onset-to-arrival time (OR = 1.02, P = .04). There was no statistically significant difference in the odds of receiving timely tPA for multimodal versus unenhanced CT (OR = 3.99, P = .07). CONCLUSIONS In our single-center experience, the use of multimodal imaging in patients with acute stroke did not delay IV tPA beyond 60 minutes. Further study is needed to assess the feasibility of the routine use of multimodal imaging in the acute stroke setting.
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Affiliation(s)
- K M Salottolo
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
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Affiliation(s)
- Darcy Day
- Darcy Day is a staff nurse in the emergency department, the medical intensive care unit, and the crisis nurse program at The Queens Medical Center in Honolulu, Hawaii
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Reply. J Emerg Nurs 2010. [DOI: 10.1016/j.jen.2010.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R87. [PMID: 20470381 PMCID: PMC2911721 DOI: 10.1186/cc9018] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 03/08/2010] [Accepted: 05/14/2010] [Indexed: 11/29/2022]
Abstract
Introduction This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intra-hospital transport (IHT). Methods Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied. Results This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A check-list for quick execution of IHT is then put forward and justified. Conclusions Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit analysis are currently the only deciding factors. A critically ill patient, prepared and accompanied by an inexperienced team, is a risky combination. The development of adapted equipment and the widespread use of check-lists and proper training programmes would increase the safety of IHT and reduce the risks in the long-term. Further investigation is required in order to evaluate the protective role of such preventive measures.
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Affiliation(s)
- Benoît Fanara
- Department of Emergency Medicine, Jean Minjoz University Hospital, 25030 Besançon, France.
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