Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study

Abstract

Background: Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur. Objectives: The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients. Methods: As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n ¼ 15) and physicians (n ¼ 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches. Results: Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards. Conclusions: To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.

Front‐line nurses' perceptions of intra‐hospital handover

“…Development of a handover standard operating protocol (SOP) may assist with process issues such as who transfers the patient. Similar to previous work, nurses consider patient acuity and safety as a driving factor when preparing for patient transfer (Bergman, Pettersson, Chaboyer, Carlström, & Ringdal, 2019). SOPs can guide nurses' decision-making for transfers, prompting them to assess predetermined patient risk factors prior to transfer and ensure the transfer team has the right level of knowledge and skills (Alamanou & Brokalaki, 2014).…”

Proactive risk assessment of intrahospital transport of critically ill patients from emergency department to intensive care unit in a teaching hospital and its implications

“…The transport ability includes the ability of first aid, observation, communication and continuous provision of professional and highquality care for patients during the transport Bergman et al, 2020a;Bergman et al, 2020b). Professional transport personnel can effectively prevent and deal with adverse events related to the disease and equipment, especially in case of changes of patient's condition.…”

“…Although good practice or expert consensus has been published about mitigating risks in IHT, it is important to examine the risk situation in individual institution for the reason that procedures, facilities and staffing may vary from one institution to another, and the tolerance of the risk conditions also varies among the healthcare staff. Adverse events of IHT have been successively reduced through evidence-based nursing (Bergman et al, 2020a;Branson & Rodriquez, 2020;Day, 2010). Health Failure Mode and Effects Analysis (HFMEA) is an approach enabling each element of one process to be attributed a cumulative numerical value which then used to priorities the actions taken against this particular element (Tiao et al, 2021).…”

OUP accepted manuscript

“…We chose to investigate clinicians’ behaviour and experiences with patient safety incidents through the ‘Critical Incident Technique’ (CIT) ( 19 ). Since its original development ( 20 ), CIT has proven useful in addressing tacit knowledge and actual performance in incidents occurring in hospitals ( 21 ) and general practice ( 15 ). We judged patient safety incidents to be critical incidents.…”