PMID- 34622520
OWN - NLM
STAT- MEDLINE
DCOM- 20220808
LR  - 20220810
IS  - 1365-2702 (Electronic)
IS  - 0962-1067 (Linking)
VI  - 31
IP  - 17-18
DP  - 2022 Sep
TI  - Proactive risk assessment of intrahospital transport of critically ill patients 
      from emergency department to intensive care unit in a teaching hospital and its 
      implications.
PG  - 2539-2552
LID - 10.1111/jocn.16072 [doi]
AB  - AIMS AND OBJECTIVES: To explore the effects of the health failure mode and effect 
      analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients 
      from emergency department (ED) to the intensive care unit (ICU). BACKGROUND: 
      Patients who were transported from ED to ICU is highly critical. IHT of these 
      patients is potentially risky, which may associate with adverse events (AEs). The 
      concern of safe IHT can be addressed by performing proactive risk assessments 
      using HFMEA and implementing the findings after the ED of our hospital being 
      reconstructed. DESIGN: A qualitative action research study combined with a 
      quantitative cross-sectional method. METHODS: According to the HFMEA method, the 
      failure modes of IHT were identified and analysed, and the effect of alterations 
      was verified. We built a project team, drawn up a IHT flow chart, defined steps 
      of IHT, classified the failure modes, calculated risk priority number and 
      analysed by the decision tree, then formulated an action plan and verified the 
      effects of the alterations. Incidence of AEs of transport was compared before and 
      after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process. 
      RESULTS: The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT 
      process. From this, 64 potential failure modes were identified, with 17 modes 
      having a RPN score higher than 8. Determined by the decision tree, there were 20 
      priority control failure modes, of which 16 involved 8 IHT alterations. Notable 
      work-flow alterations included use of a three-stage hierarchical transport 
      strategy based on patients' condition assisted by the intelligent assessment 
      system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after 
      the implementation of HFMEA (p < 0.05). CONCLUSION: Application of the HFMEA in 
      optimising IHT process can improve the safety of transportation, which is worthy 
      of promotion. Hierarchical transport scheme can reduce the incidence of AEs in 
      IHT of critical emergency patients, which mainly includes the integration and 
      construction of the transport team, equipment configuration and patient 
      information system based on the classification of patients' condition. RELEVANCE 
      TO CLINICAL PRACTICE: Nurses play a crucial role in the IHT process. HFMEA can be 
      adopted for proactive risk assessment of critically ill patients' IHT from ED to 
      ICU which involves multiple processes. The IHT hierarchical strategy based on the 
      results of failure mode analysis should be more widely used to further verify its 
      clinical effects.
CI  - (c) 2021 John Wiley & Sons Ltd.
FAU - Zhang, Weiying
AU  - Zhang W
AD  - Department of Nursing, Shanghai East Hospital, Tongji University School of 
      Medicine, Shanghai, China.
FAU - Lv, Jianhong
AU  - Lv J
AD  - Intensive Care Unit, Shanghai East Hospital, Tongji University School of 
      Medicine, Shanghai, China.
FAU - Zhao, Jin
AU  - Zhao J
AD  - Department of Nursing, Shanghai East Hospital, Tongji University School of 
      Medicine, Shanghai, China.
FAU - Ma, Xiaoyan
AU  - Ma X
AD  - Intensive Care Unit, Shanghai East Hospital, Tongji University School of 
      Medicine, Shanghai, China.
FAU - Li, Xueyan
AU  - Li X
AD  - Department of Nursing, Shanghai East Hospital, Tongji University School of 
      Medicine, Shanghai, China.
FAU - Gu, Hongming
AU  - Gu H
AD  - VIP Care Unit, Shanghai East Hospital, Tongji University School of Medicine, 
      Shanghai, China.
FAU - Zhang, Meiying
AU  - Zhang M
AD  - Emergency Department, Shanghai East Hospital, Tongji University School of 
      Medicine, Shanghai, China.
FAU - Zhou, Runv
AU  - Zhou R
AD  - Department of Nursing, Shanghai East Hospital, Tongji University School of 
      Medicine, Shanghai, China.
LA  - eng
GR  - Outstanding Leaders Training Program of Pudong Health Bureau of Shanghai/
GR  - Important Weak Subject Construction Project of Pudong Health and Family Planning 
      Commission of Shanghai/
GR  - Shanghai Nursing Association/
GR  - Shanghai East Hospital Talent Program/
PT  - Journal Article
DEP - 20211008
PL  - England
TA  - J Clin Nurs
JT  - Journal of clinical nursing
JID - 9207302
MH  - *Critical Illness
MH  - Cross-Sectional Studies
MH  - Emergency Service, Hospital
MH  - Hospitals, Teaching
MH  - Humans
MH  - *Intensive Care Units
MH  - Risk Assessment/methods
MH  - Safety Management
MH  - *Transportation of Patients
OTO - NOTNLM
OT  - adverse events
OT  - critically ill patients
OT  - emergency department
OT  - healthcare failure mode and effects analysis
OT  - intrahospital transport
OT  - safety management
EDAT- 2021/10/09 06:00
MHDA- 2022/08/09 06:00
CRDT- 2021/10/08 07:33
PHST- 2021/08/23 00:00 [revised]
PHST- 2021/05/18 00:00 [received]
PHST- 2021/09/20 00:00 [accepted]
PHST- 2021/10/09 06:00 [pubmed]
PHST- 2022/08/09 06:00 [medline]
PHST- 2021/10/08 07:33 [entrez]
AID - 10.1111/jocn.16072 [doi]
PST - ppublish
SO  - J Clin Nurs. 2022 Sep;31(17-18):2539-2552. doi: 10.1111/jocn.16072. Epub 2021 Oct 
      8.