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Critical Care Medicine:
doi: 10.1097/01.ccm.0000439192.75425.bb
Oral Abstract Session: Administration & Education: PDF Only

7: USE OF SIMULATION/CHECKLIST TO IMPROVE SAFETY DURING INTRA-HOSPITAL TRANSPORT OF THE CRITICALLY ILL.

Bangar, Maneesha; Durst, Mattew; Venegas-Borsellino, Carla; Eisen, Lewis; Lizano, Danny; Dudaie, Ronen; Carlese, Anthony; Shiloh, Ariel

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Abstract

Introduction: Intra-hospital transport of critically ill patients is often necessary for patient care. However, such transport also puts patients at risk for adverse events. Some arise from preventable sources such as human error and poor communication. Safe intra-hospital transport depends on the anticipation of complications and appropriate handling complications when they arise. Methods: After Institutional Review Board approval, an observational, prospective, before-after study design was used on 23 PAs in the Critical Care Medicine environment. Each PA completed a total of 6 simulated scenarios using a HFS (SimMan - Laerdal). During each case the group was evaluated on a 20-point performance checklist including transport-specific items including: understanding principles of safe transport, knowing physiologic effects of transport, knowing transport equipment, planning for potential transport problems, using pre-transport checklist, identifying patient needs during transfer, assuming leadership role during transfer, providing handover. After the first 2 cases the PAs were given a training session and a pre-transport safety checklist was introduced. Then the PAs participated in 2 more cases for penetrating education and finally they participated in 2 more cases evaluated and scored as post-training cases. Scores between pre and post training cases were compared. Analysis was performed using STATA/IC 11.2. Results: The overall clinical performance comparing a pre vs. post training combined score improved from 61.9%+17% to 96.45%+8% (delta +34.55%, p<0.01). The knowledge required for a level 1 transport (stable condition) improved from 65.6%+14% to 98.7%+11% (+33.1% p=0.12); and for a level 2 or 3 transport (critical condition) from 61.3%+22% to 100%+0% (delta +38.6% p<0.01). The core competences with the most significant improvement were: understanding the benefit of pre-transfer check lists in clinical practice (+83%), using a structured approach for assessment of critically ill patients prior to transfer (+50%), identifying potential patient needs prior to and during transfer (+50%), and providing a clear and precise structured handover to the receiving unit (+100%). Conclusions: Complications related to the transport of critically ill patients can potentially be avoided with proper pre-transport preparation and training to handle adverse events. The implementation of a pre-transport safety checklist and simulation training are valuable educational tools for preparing PAs to oversee the intra-hospital transport of critically ill patients.(C) 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins
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