Outcomes of interfacility critical care adult patient transport: a systematic review

MacDonald, Russell D.; Adhikari, Neill K. J.; Scales, Damon C.; Wax, Randy S.; Stewart, Thomas E.; Ferguson, Niall D.; Marquis, François

doi:10.1007/bf03022513

Cited by 3 publications

(5 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1] Studies have shown that AEs during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A literature review in 2015, based on 33 recently published studies on complications during CCTs of adult patients, found that inter-hospital transfers had an AE rate as high as 34%. [5] This appears to be corroborated by a local study among paediatric admissions at a tertiary hospital which showed an AE rate of between 27% and 36%.…”

Section: Discussionmentioning

confidence: 99%

“…[5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting.…”

mentioning

confidence: 99%

“…[4] Studies have shown that adverse events (AEs) during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting. [7] The study found that the transfers were predominantly undertaken by paramedics (82%) via road ambulance (76%).…”

mentioning

confidence: 99%

See 2 more Smart Citations

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Venter

Stassen

2016

S Afr J Crit Care

View full text Add to dashboard Cite

Background. Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics' training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners. There is currently a critical shortage of intensive and specialist care in South Africa (SA). [1] In fact, 77% of state healthcare facilities and 16% of private healthcare facilities do not have intensive or high-care capacity.[1] Owing to this shortage, adequate district and provincial healthcare might not be available in many areas, [2] necessitating frequent transfer of patients to urban tertiary centres for specialist care.Internationally, paramedics undertaking critical care transfers (CCTs) have extended scope of practice when compared with standard emergency paramedics in order to be equipped for these high-acuity patients.[3] Locally, however, all paramedics registered as advanced life support (ALS) practitioners may undertake CCTs. [4] No extended training or additional scope of practice is given to these paramedics who might need to intervene to stabilise patients for transfer.[4] Studies have shown that adverse events (AEs) during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting.[7] The study found that the transfers were predominantly undertaken by paramedics (82%) via road ambulance (76%). [7] It was found that a number of technical AEs such as inadequate monitoring, absent venous access, and malpositioning of e...

show abstract

Section: Discussionmentioning

confidence: 99%

“…[5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Venter

Stassen

2016

S Afr J Crit Care

View full text Add to dashboard Cite

show abstract

“…Open access medical services (HEMS) remains poorly understood, with no domain-specific AE taxonomy to draw from, no standardised way of defining harm, and no uniform AE reporting mechanisms. [12][13][14][15][16][17][18] Traditional methods of AE detection in healthcare typically include direct observation, morbidity and mortality review, documentation review, complaints, and voluntary reporting systems. 19 20 There is evidence to suggest that identification of AEs and harm is highly dependent on methodology employed.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Similarly, the potential for harm to occur in the delivery of emergency care by emergency medical services (EMS) is significant, and can include a multitude of contributing factors such as fatigue, differences in provider skill and training, errors in cognition and decision-making, communication, environmental factors and team dynamics 4 6–11. However, despite this potential, the incidence of AEs within the prehospital EMS and helicopter emergency medical services (HEMS) remains poorly understood, with no domain-specific AE taxonomy to draw from, no standardised way of defining harm, and no uniform AE reporting mechanisms 12–18…”

Section: Introductionmentioning

confidence: 99%

Trigger tool-based description of adverse events in helicopter emergency medical services in Qatar

Heuer,

Howard,

Stassen

2023

BMJ Open Qual

View full text Add to dashboard Cite

IntroductionAdverse events (AEs) in helicopter emergency medical services (HEMS) remain poorly reported, despite the potential for harm to occur. The trigger tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their proximal causes (PCs) in Qatar HEMS.MethodsUsing the Pittsburgh Adverse Event Tool to identify AEs in HEMS, we retrospectively analysed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for triggers, AEs and harm per 100 patient encounters, plotted measures on statistical process control charts, and conducted a multivariate analysis to report harm associations.ResultsWe identified 883 triggers in 536 patients, with a rate of 1.1 triggers per patient encounter, where 81.2% had documentation errors (n=436). An AE and harm rate of 27.7% and 3.5%, respectively, was realised. The leading PC was actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the intervention and medication triggers (n=16), where deviation from standard of care was common (37.9%; n=11). Age and diagnosis-adjusted odds were significant in the patient condition (6.50; 95% CI 1.71 to 24.67; p=0.01) and interventional (11.85; 95% CI 1.36 to 102.92; p=0.03) trigger groupings, while age and diagnosis had no effect on harm.ConclusionThe TT methodology is a robust, reliable and valid means of AE detection in the HEMS domain. While an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and documentation errors should also be addressed in future research.

show abstract

Patient safety in ambulance services: a scoping review

Fisher

Freeman

Clarke

et al. 2015

Health Services and Delivery Research

View full text Add to dashboard Cite

Objective. To examine the literature pertaining to the use of peer-led education in patient safety. Findings. Four studies met the inclusion criteria: two were conducted in health care students and two in medical practitioners. Three studies used pre-post evaluation, with one containing a comparator group. One study a post-intervention evaluation only. All studies undertook Kirkpatrick Level 2 evaluations, showing significant improvements in attitudes and knowledge. One study undertook Level 3 and 4 evaluations, showing improvement in self-reported behaviors and engagement in quality improvement initiatives. Summary. There are few studies evaluating peer-led education in patient safety and formal and high-quality evaluations are lacking.

show abstract

Outcomes of interfacility critical care adult patient transport: a systematic review

Abstract: Introduction We aimed to determine the adverse events and important prognostic factors associated with interfacility transport of intubated and mechanically ventilated adult patients.

Cited by 3 publications

References 16 publications

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

Trigger tool-based description of adverse events in helicopter emergency medical services in Qatar

Patient safety in ambulance services: a scoping review

Contact Info

Product

Resources

About