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One of my all time heroes in Emergency Medicine - Mel Herbert at EM:RAP HQ, shamelessly plugging edtcc.com blog

This is an emergency medicine blog with a focus on trauma, and critical care, along with new technology & education. In addition, we will scour the existing blogs and resources out there, and attempt to keep the reader up to date with the ever expanding blogosphere...

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Entries in safety (1)

Tuesday
Jan032012

Checklists for Intra-Hospital Transfers May Improve Safety  

This study from Seoul, published in the American Journal of Emergency Medicine in December 2011, was a "before and after" intervention trial, performed in an urban teritiary teaching hospital ED. The authors measured and recorded "unexpected events" related to devices, clinical situations, tube & line etc of all intra-hospital transfers - i.e from the ED to the wards, ICU, radiology, opertaing theatre etc. This was done prior to the introduction of a designed transport checklist for use prior to transfer, and then repeated after implementation. 

The authors found a significant reduction in the rate of total and serious unexpected events during intrahospital transfers after the intoduction of transport checklists. 

BACKGROUND:

This study was aimed to explore the effect of intervention in safe intrahospital transport on the incidence of unexpected events (UEs) occurring during the transport of emergency patients.

METHODS:

This study was performed in an urban tertiary teaching hospital emergency department (ED) from May 17 to October 30, 2010. Patients older than 15 years who were transported to general wards; intensive care units; and magnetic resonance imaging, intervention, or operation rooms were enrolled. Demographics and data on all UEs related to the devices, clinical situations, and tubes or lines were measured by registered nurses at pre- and postintervention period. The intervention was that acting nurses were required to use a designed transport checklists before the patients were transported. Primary outcomes were the rate of all and serious UEs during the pre- and postintervention periods. Serious UEs were defined as any worsening of a patient's clinical status. Statistical values were measured with 95% confidence intervals (CIs) and compared using Student t tests or χ(2) tests.

RESULTS:

In total, there were 680 transports before interventions and 605 transports after interventions. Overall, UEs decreased significantly from a value of 36.8% (95% CI, 33.1-40.5) in the preintervention period to a value of 22.1% (95% CI, 18.9-25.7) in the postintervention period (P = .001). Serious UEs in clinical status also decreased significantly from 9.1% (95% CI, 7.1-11.5) in the preintervention period to a value of 5.2% (95% CI, 3.6-7.4) in the postintervention period (P = .005).

CONCLUSION:

A significant reduction in the rate of total and serious UEs during intrahospital transport from the ED was found through using transport checklists.

Checklists have become an integral part in the surgical world, with checklists introduced after the WHO launched it's second global patient safety challenge back in 2008, in an attempt to reduce the incidence of wrong sided surgeries, and increase the operative team's preparedness for surgical and peri-anaesthetic complications. Is it time that this practise spread to other critical hospital environments too? The results of this study are certainly suggestive that it should.

Am J Emerg Med. 2011 Dec 26. [Epub ahead of print]