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

Lina Bergman; Monica Pettersson; Wendy Chaboyer; Eric Carlström; Mona Ringdal

doi:10.1016/j.aucc.2018.12.003

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

Aust Crit Care. 2020 Jan;33(1):12-19. doi: 10.1016/j.aucc.2018.12.003. Epub 2019 Jan 21.

Authors

Lina Bergman¹, Monica Pettersson², Wendy Chaboyer³, Eric Carlström⁴, Mona Ringdal⁵

Affiliations

¹ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden. Electronic address: lina.bergman@gu.se.
² Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Vascular Department, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden. Electronic address: monica.pettersson@gu.se.
³ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Menzies Health Institute Queensland, G40 Griffith Health Centre, Level 8.86, Gold Coast Campus, Griffith University, QLD 4222, Australia. Electronic address: w.chaboyer@griffith.edu.au.
⁴ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; University of Southeast Norway, Vestfold, Postbox 235, 3603 Kongsberg, Norway. Electronic address: eric.carlstrom@gu.se.
⁵ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Department of Anaesthesiology and Intensive Care, Kungälvs Hospital, SE-442 83, Kungälv, Sweden. Electronic address: mona.ringdal@fhs.gu.se.

PMID: 30674422
DOI: 10.1016/j.aucc.2018.12.003

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 = 15) and physicians (n = 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.

Keywords: Critical incident technique; Intensive care unit; Intrahospital transport; Nontechnical skills; Patient safety; Teamwork.

MeSH terms

Adult
Aged
Attitude of Health Personnel
Critical Illness*
Female
Humans
Interviews as Topic
Male
Middle Aged
Patient Safety / standards*
Patient Transfer / standards*
Quality Improvement*
Sweden
Task Performance and Analysis