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

Abstract

Aims and objectives:To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU).Background: Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs).The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed. Design:A qualitative action research study combined with a quantitative crosssectional method.Methods: According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process. Results:The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work-flow alterations included use of a three-stage hierarchical transport strategy based on patients' condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p < 0.05). Conclusion:Application of the HFMEA in optimising IHT process can improve the safety of transportation, which is worthy of promotion. Hierarchical transport scheme can reduce the incidence of AEs in IHT of critical emergency patients, which mainly includes the integration and construction of the transport team, equipment

Intrahospital Transport of Critically Ill Patients with Subarachnoid Hemorrhage—Frequency, Timing, Complications, and Clinical Consequences

“…Even though IHTs are undoubtably hazardous, guidelines from international intensive care consortia have not been updated for the last 20 years [18][19][20]. However, a number of checklists for IHT have been proposed by individual authors recently, including a study specifically addressing neurocritical care patients [21][22][23]. As these checklists mostly focus on equipment-related factors and risk stratification, the competency of the staff involved remains unaddressed.…”

Reliability and validity assessment of the Chinese version of the Intrahospital Transport Safety Scale (IHTSS) in intensive care units

“…These measures may include standardized transport protocols, checklists, and training programs for healthcare professionals involved in patient transport [ 11 ]. Healthcare professionals receive training through simulation exercises, hands-on clinical practice, classroom instruction, and continuous education programs to enhance their skills and knowledge in patient transport safety [ 12 ]. Additionally, regular reviews and updates of training materials help ensure that healthcare professionals stay informed about the latest best practices and guidelines.…”

“…The emergency department graded transport model is used for the intrahospital transport of critically ill patients in the emergency department, aiming to ensure safety during the transport process [ 27 ]. Others used Healthcare Failure Mode and Effect Analysis (HFMEA) to improve the safety of intrahospital transport of critically ill patients [ 12 ]. However, there is inconsistency among ICU nurses regarding the protocols and checklists for intrahospital transport of critically ill patients [ 28 ].…”