Patient safety incidents during interhospital transport of patients: A prospective analysis

Lyphout, Cathelijne; Bergs, Jochen; Stockman, Willem; Deschilder, Koen; Duchatelet, Christophe; Desruelles, Didier; Bronselaer, Koen

doi:10.1016/j.ienj.2017.07.008

Cited by 29 publications

(20 citation statements)

References 31 publications

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“…This point was emphasized only by the experienced doctors, describing the importance of “creating margins” for the patient by spending more time initially to facilitate a safer transport. [17]…”

Section: Discussionmentioning

confidence: 99%

Interhospital transport of critically ill patients: experiences and challenges, a qualitative study

Eiding

Kongsgaard

Braarud

2019

Scand J Trauma Resusc Emerg Med

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Background No consensus based national standard for interhospital transports of critically ill patients exists in Norway. The local hospitals are responsible for funding, organizing and performing these transports, resulting in potentially different level of care for the critically ill patients depending on local hospital resources and not the level of severity in the patient’s condition. The aim of this study was to examine how these transports are executed and to discover challenges during transports and potentials of improvement. Methods A qualitative study with 20 semi-structured interviews of doctors, nurses and ambulance personnel representing a wide range in experience and formal education, reflecting the different compositions of crews performing interhospital transports was conducted. A systematic text condensation of the interviews was performed to describe personal experiences and values. Results Few interviewees reported special adverse events when asked. Instead they chose to describe more general characteristics of the working environment, their own positive emotions or fears and the strengths and weaknesses of the organizational system. The prehospital working environment was described as different from the in-hospital environment. The personnel experienced being on their own during transports, lack of procedures and checklists and often no systematic education or demanded preparedness for participating. The resident doctors described pressure from elderly colleagues to participate in the transports. At the same time, all interviewees reported a self-interest in participating in these transports. Conclusions Safe interhospital transports of the critically ill patients are challenged by the characteristics of the out of hospital environment. The transports are described as potentially unsafe for both patients and personnel. Systematic education is warranted, highlighting the use of checklists and special educational programs in prehospital critical care medicine. The strong personal interest to participate in these transports may serve as a barrier against changing todays system. To ensure the right level of competence and safety for each unique patient, it is imperative to standardize the interhospital transports on a national level, built on consensus from experienced prehospital personnel. Trial registration The trial is approved and registered by the local representative for the Norwegian Data Protection Authority as trial 13–7751. Electronic supplementary material The online version of this article (10.1186/s13049-019-0604-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Interhospital transport of critically ill patients: experiences and challenges, a qualitative study

Eiding

Kongsgaard

Braarud

2019

Scand J Trauma Resusc Emerg Med

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“…The risks are substantial, as intubated patients with respiratory failure commonly desaturate during transport (13). There is also a significant risk of tube or line dislodgement both with prone position (14), and this could be devastating if it occurred in transport (7)(8)(9)(10). Therefore, transporting an intubated prone patient has been rare, with the largest series to date being comprised of seven transports of intubated patients (15).…”

Section: Discussionmentioning

confidence: 99%

“…Given the substantial risks of transporting patients prone, transporting patients in this position has not been common (5,6). Adverse events are frequent in transport (7)(8)(9)(10), and could be life-threatening if they were to occur with a patient in a prone position, prohibiting the CCT team from accessing the airway. To our knowledge, there are no existing reports of transporting awake, nonintubated patients in the prone position.…”

Section: Introductionmentioning

confidence: 99%

Transport of a Nonintubated Prone Patient with Severe Hypoxemic Respiratory Failure Due to COVID-19

Boomhower¹,

Noland²,

Frakes³

et al. 2020

Prehospital Emergency Care

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With the COVID-19 pandemic, healthcare systems have been facing an unprecedented, large-scale respiratory disaster. Prone positioning improves mortality in severe hypoxemic respiratory failure, including COVID-19. While this is effective for intubated patients with moderate-tosevere ARDS, it has also been shown to be beneficial for non-intubated patients. Critical care transport (CCT) has become an essential component of combating COVID-19, frequently transporting patients to receive advanced respiratory therapies and distribute patients in concert with available resources. With increasing awake proning, CCT teams may encounter patients supported in the prone position. Historically, transporting in the prone position has not been embraced due to substantial risks of desaturation during transport. In this case report, we describe the first known report of transporting a non-intubated, critically ill COVID-19 patient in the prone position.

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“…To our knowledge, the current study is the first to use observations and video recordings to explore the patient’s situation during the entire interhospital transfer process. One could argue that intensive care unit-to-unit transfers nowadays are relatively safe considering the low mortality rates and fewer number of adverse events (Broman, Holzgraefe, Palmér, & Frenckner, 2015; Janz et al, 2017; Lyphout et al, 2018). Yet, based on our results, we argue that interhospital transfers of this vulnerable group of patients may have a variety of consequences for the patient.…”

Section: Discussionmentioning

confidence: 99%

The Patient’s Situation During Interhospital Intensive Care Unit-to-Unit Transfers: A Hermeneutical Observational Study

et al. 2019

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Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient’s situation during interhospital intensive care unit-to-unit transfers. Data collection from eight transfers resulted in over 7 hours of video material and field notes. Using a hermeneutical approach, three themes emerged: being visible and invisible; being in a constantly changing space; and being a fettered body in constant motion. The patient’s situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel’s attention and where movements from the journey become part of the patient’s body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel’s ability to maintain a caring atmosphere around these patients.

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Patient safety incidents during interhospital transport of patients: A prospective analysis

Cited by 29 publications

References 31 publications

Interhospital transport of critically ill patients: experiences and challenges, a qualitative study

Interhospital transport of critically ill patients: experiences and challenges, a qualitative study

Transport of a Nonintubated Prone Patient with Severe Hypoxemic Respiratory Failure Due to COVID-19

The Patient’s Situation During Interhospital Intensive Care Unit-to-Unit Transfers: A Hermeneutical Observational Study

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