standardized intervention in pediatric critical care transport - - PowerPoint PPT Presentation

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standardized intervention in pediatric critical care transport - - PowerPoint PPT Presentation

Nov 23, 2023 222 likes •440 views

Improving patient safety with a standardized intervention in pediatric critical care transport Kristen A. Smith, MD July 25, 2014 1 Background Communication failure is leading cause of adverse events: Medication errors Delays in

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Improving patient safety with a standardized intervention in pediatric critical care transport

Kristen A. Smith, MD July 25, 2014

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Background

  • Communication failure is leading cause
  • f adverse events:

– Medication errors – Delays in diagnosis – Delays in definitive care – Repeats in diagnostic testing – Omissions of care

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Background

  • Last year in Johns Hopkins Children’s

Center:

– > 65 reported medication errors – > 100 reported duplications in diagnostic work-up – > 150 reported delays in patient care due to inadequate medical record from referral hospital

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Background

  • Transitions in care are prime examples

when communication breakdown can lead to patient harm

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Background

Patient presents to community hospital for care Care of patient transferred to transport personnel to bring child to Johns Hopkins Children’s Center Patient admitted to Pediatric Intensive Care Unit (PICU)

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2,500/ year 300/ year

Patient hand-off point

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Background

  • Transport Team

– Nurses – Paramedics – Respiratory Therapists – Physicians

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NO FORMALIZED WAY TO EXCHANGE PATIENT INFORMATION!

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Hypothesis

  • Adverse events will be reduced after

implementation of a standardized intervention for patients transported directly to the pediatric intensive care unit (PICU) from outside hospitals by the pediatric transport service.

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Timeline

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Oct 2013 Mar 2014

Pre-implementation Data Post-implementation Data

Mar 2015 Oct 2014 Aug 2014

Education & Training Implementation

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Intervention

  • Didactic lecture
  • Simulation experience
  • Patient hand-off script

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  • Transport RN/MD
  • Patient demographics: Name, age, weight, allergies
  • CC/HPI: Brief summary
  • OSH Work-up/therapies: Labs (completed & pending), diagnostic and

radiographic testing, medications, treatments

  • Transport team therapies: Assessment, meds, response the therapies
  • * Pause for questions/clarification

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  • Transport RT (if applicable)
  • Assessment
  • Interventions and responses to treatments
  • Intubation (if applicable): ETT size, depth
  • Any additional information required for patient care
  • * Pause for questions/clarification

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  • Accepting Provider (MD/NP)
  • Summarize working diagnosis
  • Review of Plan:
  • Neuro: pain issues, neuro checks, seizure plan, sedation plan
  • Cardio/Resp: Monitoring, frequency of treatment(s), resp support needs (NC,

BiPap/CPAP, etc)

  • FEN/GI: Diet, fluids
  • ID: Antibiotic plan
  • Gen Care: Labs, access, foley
  • *Pause for questions/clarification

Transport Hand-off Script

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Outcomes

  • Primary

– Medication errors

  • Secondary

– Delays in diagnosis or definitive care

  • i.e. surgery

– Repeats in diagnostic testing – Omissions of care

  • All adverse events must occur within 48

hours of transfer

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Outcomes

  • Ascertainment

– Patient Safety Network (PSN)

  • Online, anonymous adverse event reporting

system

  • Used by nurses, physicians, pharmacy staff,

respiratory therapy for over 10 years at Johns Hopkins

– Data will be retrospectively analyzed from existing database

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Study Population

  • Inclusion criteria

– Age birth-22 years – Transported directly to PICU by Johns Hopkins pediatric transport service

  • >300 annually
  • Exclusion criteria

– Patients transported by another medical vendor – Patients triaged through emergency department (ED) prior to PICU admission

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Statistical Analysis

  • Chi-square comparison of number of

adverse events per transfer pre- implementation and post-implementation

– Medication errors – Delays in diagnosis or definitive care – Repeats in diagnostic testing – Omissions of care

7/30/2014 15

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Limitations

  • Retrospective review
  • Historical data used for control
  • Single-center study
  • Adverse event reporting system does

not catch all events

  • No existing data proving link between

adverse events and communication issues

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Significance

  • Reducing adverse events during transport

could save lives

  • Johns Hopkins Children’s Center’s Pediatric

Transport Team transports over 2,500 patients each year to our facility

– Each transport involves multiple exchanges of information that could be vital to that patient’s care

  • After project completion, the hope is to use

these tools throughout the children’s center to improve patient hand-off

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Acknowledgements

  • Dr. Lawrence Appel - instructor
  • Dr. Kuni Matsushita - instructor
  • Dr. Mariana Lazo-Elizondo - instructor
  • Dr. Maria Brinez Giraldo
  • Dr. Anda Gonciulea
  • Dr. Sahar Koubar
  • Dr. Heather Weinreich

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QUESTIONS?

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