Patient Safety Events during Critical Care Transport.

OBJECTIVE: Patient safety events (PSEs) occurring during interfacility transport have not been studied comprehensively in critical care transport (CCT) teams in the United States. The purpose of this research was to investigate the type and frequency of PSEs during CCT between hospitals; to explore the impact of patient stability, vulnerability, complexity, predictability, and resiliency; and to examine if the nurse factors of licensure or experience and transport factors of duration or mode of transport influence the frequency of PSEs. The study was conducted at a large hospital-based quaternary health care system in the Midwestern United States. METHODS: This was a retrospective, descriptive correlational study using chart review. The study selected 50 sequential qualifying cases with PSEs and randomly selected control cases reviewed at a single site over a 5-month period. RESULTS: The rate of PSEs was 27.7 events per 1,000 patient contacts. Of 9 reported adverse event types, new or recurrent hypoxia had the greatest frequency. Hypoxia, when present at the time of initial CCT contact, was associated with the PSE occurrence (P = .046). Duration of transport was a significant predictor of PSEs (P = .025). CONCLUSION: Pretransport hypoxia and duration of transport are independent predictors for intratransport PSEs, particularly intratransport hypoxia.

Validity and Reliability of the Transport Triage Tool.

BACKGROUND: Standards for interfacility transport in the United States recommend that each transport request be triaged to ensure that each patient is transported by an appropriate mechanism and by the appropriate clinicians in order to meet the patient's intratransport needs. No instrument currently exists to meet that need. The Transport Triage Tool, a novel instrument, has been designed to determine the clinician (paramedic, registered nurse, or advanced practice registered nurse) who will best meet the patient's needs during transport. OBJECTIVE: To assess psychometric elements-that is, validity and reliability-of the Transport Triage Tool when used by health care professionals in determining which clinician is appropriate for interfacility transport. METHODS: A 3-step process was used to initially evaluate the reliability and validity of this tool when assigning a lead clinician during transport. Content and predictive validity were evaluated. Both intrarater and interrater agreement were used to examine reliability. RESULTS: Predictive validity was supported by an area under the receiver operating characteristic curve of 0.847 and a Youden index of 0.31. Percentage agreement and Cohen κ were reasonable across all periods of testing. CONCLUSIONS: The Transport Triage Tool has acceptable predictive validity and reliability; however, this preliminary evaluation indicates that further refinement is needed. Large tertiary centers that offer variations in transport team composition may be able to use the Tool in its present form to train and evaluate individuals who make decisions regarding interfacility transport, although additional testing and evaluation are recommended.

Adaptation of the AACN Synergy Model for Patient Care to critical care transport.

Today's health care delivery system relies heavily on interhospital transfer of patients who require higher levels of care. Although numerous tools and algorithms have been used for the prehospital determination of mode of transport, no tool for the transfer of patients between hospitals has been widely accepted. Typically, the interfacility transport decision is left to the discretion of the referring provider, who may or may not be aware of the level of care provided or the means of transport available. A need exists to determine the appropriate level of care required to meet the needs of patients during transport. The American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care is a patient-centered model that focuses on optimizing patient care by matching the characteristics of the patient with the competencies of the nurse. This model shows significant promise in providing the theoretical backing to guide the decision on the level of care necessary to complete interfacility transfers safely and effectively. This article describes a new tool inspired by the AACN Synergy Model for Patient Care to determine the appropriate level of care required for interfacility transport.