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 diagnosis Delays in definitive care Repeats in diagnostic testing Omissions of care 2
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 3
Background Transitions in care are prime examples when communication breakdown can lead to patient harm 4
Background Patient presents to community hospital for care Care of patient transferred to transport personnel to bring child to Johns Hopkins Children s Center 2,500/ year Patient admitted to Pediatric Intensive Care Unit (PICU) 300/ year Patient hand-off point 5
Background Transport Team Nurses Paramedics Respiratory Therapists Physicians NO FORMALIZED WAY TO EXCHANGE PATIENT INFORMATION! 6
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. 7
Timeline Oct 2013 Pre-implementation Data Mar 2014 Aug 2014 Oct 2014 Post-implementation Data Mar 2015 Education & Training Implementation 8
Intervention Didactic lecture Simulation experience Patient hand-off script 9
1 2 3 Transport Hand-off Script 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 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 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 10 *Pause for questions/clarification
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 11
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 12
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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 14
Statistical Analysis Chi-square comparison of number of adverse events per transfer preimplementation and post-implementation Medication errors Delays in diagnosis or definitive care Repeats in diagnostic testing Omissions of care 7/30/2014 15
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 16
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 17
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 18
QUESTIONS? 19