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Patient Safety Events During Critical Care Transport

Swickard, Scott W
http://orcid.org/0000-0001-9707-9541
http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671

Abstract Details

2016, Doctor of Philosophy, Case Western Reserve University, Nursing.
Purpose Statement The purpose of this retrospective chart review was to investigate the type and frequency of patient safety events (PSE) during critical care transport (CCT) between hospitals and explore the patient characteristics, nursing competencies, and environmental factors impact on PSE. Research Questions Research questions were: 1. What are the types and frequencies of patient safety events that occur when registered nurses (RNs) and advanced practice nurses (APNs) are lead clinicians in ground, rotor and fixed-wing vehicles? 2. What is the impact of the patient characteristics of stability, vulnerability, complexity, predictability, and resiliency on frequency of patient safety events? 3. Do the nursing competencies of caring practices and clinical judgment, have a mediating or moderating role on the frequency PSE? 4. Do modifiable environmental factors (i.e., time outside of the ICU and mode of transport) influence the frequency of PSE? Method This was a descriptive, comparative review of 5 months of records at a quaternary academic medical center. Inclusion criteria were all inter-hospital transports via ground, rotor, and fixed wing transport. Cases with PSE reported were compared to randomly selected non-PSE cases (ratio 1 PSE: 8 non-PSE cases). Logistic regression was used to determine relationships among the variables of interest with the occurrence of PSE. Results The rate of PSE was 2.65% among all qualifying cases. A total of 440 cases were reviewed and entered into the database (48 with PSE: 392 without PSE). Adverse events were the most common type of PSE (1.88%), and new or recurrent hypoxia was the most frequent type of adverse event. The patient characteristic of stability was significant (p=0.083, OR 1.059, 95% CI 0.993-1.113). Secondary analyses supported the association of hypoxia, a component of stability, with PSE. The nursing competency of clinical judgment, as measured by experience in years of transport employment of the lead clinician, was identified as a potential moderator of hypoxia-related PSE. Duration of transport demonstrated the most consistent relationship with PSE in secondary analysis. Conclusion Hypoxia, defined as new or recurrent decrements in peripheral oxygenation, emerged as a new consideration for evaluating patients risk for CCT PSE.
Chris Winkelman, PhD (Committee Chair)
Mary Kerr, PhD (Committee Member)
Andrew Reimer, PhD (Committee Member)
Fred Hustey, MD (Committee Member)
149 p.
Nursing
Patient Safety Events; critical care transport; inter-facility transport

Recommended Citations

Citations

  • Swickard, S. W. (2016). Patient Safety Events During Critical Care Transport [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671

    APA Style (7th edition)

  • Swickard, Scott. Patient Safety Events During Critical Care Transport. 2016. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671.

    MLA Style (8th edition)

  • Swickard, Scott. "Patient Safety Events During Critical Care Transport." Doctoral dissertation, Case Western Reserve University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671

    Chicago Manual of Style (17th edition)

case1468431671
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© 2016, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.