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Quality improvement report
Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness
  1. Shwu-Jen Lin1,
  2. Chin-Yuan Tsan2,
  3. Mao-Yuan Su3,
  4. Chao-Ling Wu1,
  5. Li-Chin Chen4,
  6. Hsiu-Jung Hsieh2,
  7. Wei-Ling Hsiao2,
  8. Jui-Chen Cheng1,
  9. Yao-Wen Kuo1,
  10. Jih-Shuin Jerng4,5,
  11. Huey-Dong Wu1,
  12. Jui-Sheng Sun4,6
  1. 1Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
  3. 3Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
  4. 4Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
  5. 5Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  6. 6Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
  1. Correspondence to Dr Jih-Shuin Jerng; jsjerng{at}ntu.edu.tw

Abstract

Aim Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation.

Design and implementation We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme.

Results The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001).

Conclusion The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.

  • critical care
  • patient safety
  • respite care
  • team training
  • transportation of patients
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2019-000698

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    Footnotes

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    • Contributors SJL, CYT, MYS, LCC and JSJ planned the study. SJL, CYT, MYS, CLW, LCC, HJH, WLH, JCC, YWK and JSJ participated in the generation of improvement strategies and methods. SJL, MYS, CLW, HJH, WLH and JCC directed the implementation of improvement strategies. SJL, CLW, HJH and WLH carried out the audits. SJL, CLW, LCC, HJH, WLH and JCC collected the data. SJL, LCC and JSJ analysed the data. CYT, JSJ, HDW and JSS supervised the improvement programme and study. SJL and YWK wrote the draft of the manuscript. JSJ and HDW revised and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The Institutional Research Ethics Committee of our hospital approved the study and waived the need for informed consent from the patients and workers participating in the programme (201703095RINC).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon request.