Development of an interfacility transport program for critically ill cardiovascular patients

The expanding use of newer coronary artery intervention modalities in the treatment of critically ill cardiac patients has produced a profound change in the manner in which acute care is rendered to these patients. To meet the needs of community hospitals and to improve the safety of interfacility transport to tertiary care centers, a transport program was developed at The Hospital of the Good Samaritan, Los Angeles, California. Rapid transport by helicopter, fixed-wing aircraft or specialized ground ambulance services has been used to improve patient transit time and safety of transfer between the community hospital and tertiary care facility. Experience at The Hospital of the Good Samaritan (1,012 consecutive patients) compares favorably with other programs and proves to be safe and beneficial.     

Outcomes of interfacility critical care adult patient transport: a systematic review

Introduction  

We aimed to determine the adverse events and important prognostic factors associated with interfacility transport of intubated and mechanically ventilated adult patients.     

Patient care during interfacility transport: a narrative review of managing diverse disease states

BACKGROUND: When critically ill patients require specialized treatment that exceeds the capability of the index hospitals, patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care. Therefore, appropriate and efficient care for patients during the process of transport between two hospitals(interfacility transfer) is an essential part of patient care. While medical adverse events may occur during the interfacility transfer process, there have not been evi...     

绩效考核在夜间护理质量管理中的作用

目的探讨绩效考核在提高夜间护理质量中的作用。方法制订夜间护理绩效考核评价内容和方法,将夜间护理质量纳入绩效考核中。比较实施绩效考核前后夜间护理质量和患者满意度的差异。结果实施绩效考核后全院夜间护理质量和患者满意度均较考核前提高,考核前后比较,均P<0.01,差异具有统计学意义。结论将夜间护理工作纳入绩效考核,提高了夜间护理质量和患者的满意度,有效地规范了护士行为。     

Pro/con debate: Do the benefits of regionalized critical care delivery outweigh the risks of interfacility patient transport?

You are providing input in planning for critical care services to a large regional health authority. You are considering concentrating some critical care services into high-volume regional centres of excellence, as has been done in other fields of medicine. In your region, this would require several centres with differing levels of expertise that are geographically separated. Given there are inherent risks and time delays associated with interfacility patient transport, you debate whether these potential risks outweigh the benefits of regional centres of excellence.     

Measuring gait-related blind mobility performance

The gait characteristics of blind travelers can provide information about their mobility skills. Previous attempts at measuring these characteristics have suffered because they either do not provide continuous monitoring or allow usage outside a laboratory setting. A new instrument has been developed to overcome these problems. The instrument allows continuous monitoring of interankle distance during walking. Records of interankle distance were analyzed to determine maximum interankle distance/step, step time, and cadence. With this system, gait parameters revealed differences between two groups of travelers (blind and blindfolded) and changes over a series of four trials on turns, straightaways, and over the whole route. This suggests the system is useful as an assessment device both for research and for rehabilitation training.     

Measuring and managing pain and performance

Pain and movement dysfunction are invariant sensory and motor expressions of health disorders. They are also complex, inter-related problems and may be accompanied by fatigue and depressed mood. Optimum management is predicated on the appropriate selection, application and interpretation of assessment measures. Research on pain and physical function using physical performance tests has shown that regardless of whether pain and impairment is a consequence of musculo-skeletal injury or systemic disease such as cancers, pain-free individuals outperform those with pain in terms of movement speed and endurance ability across a variety of performance tests (e.g. walk and reach tests, and repeated sit-to-stand and trunk flexion tests). Slow movements are characterized by fractionated and extraneous movement patterns. They are also associated with a relatively high level of muscle activity (amplitude and duration) throughout the task compared to fast movements. Slow movements are also relatively inefficient in terms of physiological energy and time burden. For a similar level of effort, individuals with pain are able to perform significantly less work. Our research has shown that individuals with pain move slower across a range of self-selected movement speeds i.e. slow, preferred and fast speeds. It is also apparent that patients systematically over estimate expected pain during task performance at faster speeds. Preliminary work using speed targeted treatment shows promise in terms of improving physical performance and reducing the burden of illness and physical dysfunction.     

Mayo Clinic's hospital-based emergency air medical transport service

Mayo Clinic's hospital-based helicopter transport service, which is staffed by a medical flight crew consisting of two critical-care nurses, was initiated in October 1984. To date, more than 2,500 patients with a wide range of life-threatening conditions have been transported. As a quality-assurance tool, a computerized data collection system was initiated in 1986, and this report details a 3-year experience in air transport garnered prospectively. From 1986 through 1988, 1,701 flights were completed in response to 2,329 requests for transport. Overall, 10% of requests were declined because of weather. Of 1,727 patients transported, 94% were brought to the Mayo Medical Center for care. The categories of the patients were medical-surgical in 1,071 (62%), trauma in 553 (32%), and neonates in 103 (6%). Most transports (93%) originated from referral inpatient facilities or emergency rooms; the rest were scene flights or transports from Mayo to other facilities. The mortality rate among the 1,632 patients brought to the Mayo Medical Center was 16.3%. The mean distance transported was 77 miles for interhospital and 23 miles for scene flights. For both trauma and medical-surgical patients, the severity of illness was evaluated with use of recognized quantitative scoring systems. Prospective collection of data has proved useful in program administration, quality assurance, and clinical research. Mayo Clinic's hospital-based helicopter transport program has served as a logical extension of the institution's emergency-care capabilities in an effort to enhance the prehospital and interhospital care of the critically ill within the institution's referral area.     

The influence of insurance type on interfacility pediatric emergency department transfers

Background

Disparities exist in the care children receive in the emergency department (ED) based on their insurance type. It is unknown if these differences exist among children transferred from outside EDs to pediatric tertiary care EDs.

Measuring the performance of audible alarms for anaesthesia

The ergonomic performance of an integrated set of 17 audible alarm sounds, divided into low, medium and high priority classes has been undertaken. The sounds were tested for their ease of learning/recall, and how closely their intrinsic perceived urgency matched to a clinical assessment of urgency. The tests were computer-administered and performed on 21 volunteers aged from 18 to 52, in two sessions a few days apart. Session 1 taught the meanings of the alarm sounds and session 2 measured the performance of the sounds. The mean correct identification rate for the sounds was 48.4% (range 10.3-90.0%) with 97.5% of misidentifications within sound priority class. The urgency correlation was statistically significant (r=0.85, p<0.001) with all priority classes included but within priority class correlations were not statistically significant. Poor within priority class performances were ascribable to a priori aspects of the design of the sound system.     

Analytical quality, performance indices and laboratory service

Faulty data lead to suboptimal diagnostics and decision making unless the flaw is known and amenable to correction. However, pure noise (added analytical variance) has only minor effects on clinically appropriate indices of diagnostic performance. This fact is illustrated by an idealized screening programme, using the preventive benefit-to-cost ratio as the index of performance. Further, this article illustrates that the effect of an unnoticed source of noise is roughly just twice the effect that the same noise will have when its magnitude is known and clinical decision limits are adjusted accordingly. Owing to the small size of these effects, however, it may be profitable to spend resources on other aspects of good laboratory service, such as timeliness, documentation and interpretative support.