Best Practice
Intrahospital Emergency Personnel Transport
The Johns Hopkins Hospital
Points of Contact:
Jim Scheulen, Medical Director of Administration, 410.955.5204, ;
Scott Newton, Assistant Director of Nursing, 410.502.0935, ;
Dennis Jones, Nurse Clinician III- PACE, 410.614.7777, ;
Shawn Brast, Nurse Clinician III- PACE, 410.614.7777, ;
Nancy Cushman, Assistant Director Hopkins Access Line, 443.287.7230, .
Submitted by Melissa Gue
02 May 2014
Executive Summary: Transporting patients for critical tests and procedures is challenging and can be risky. In response to multiple complaints of clinically adverse events occurring during patient transport, The Johns Hopkins Hospital created an intrahospital transport service, modeled after out-of-hospital transport. A process for other hospitals to emulate: it has proved very successful in mitigating patient safety risks associated with transporting critically ill patients.
Intrahospital Emergency Personnel Transport- The Johns Hopkins Hospital
Objective of the Best Practice: Patient safety and stability is of upmost importance when transporting patients, especially critically ill Level’s III and IV patients. The objective of the intrahospital transport service is to mitigate the risk of clinically adverse events occurring during the round trip transport of patients from inpatient wards to receive critical tests and procedures. The team is responsible for ensuring safety and stability of the patient, as well as seamless continuity of care from the transfer to the transport team from bedside staff, to the ancillary clinical staff, and returning the patient to the inpatient clinical care team.
Background: The Johns Hopkins Hospital (JHH) is a 1059-bed facility consisting of 8 ICUs, 7 telemetry units, and various other medical/surgical units. It is a Level 1 trauma center, and the designated referral center in the state of Maryland for pediatric trauma, burns, and all eye emergencies. In 1992, it created Lifeline, which provides advanced life support and critical care transport for patients to and from other medical facilities via ground and air (helicopter and fixed-wing). A Comprehensive Unit-Based Safety Program (CUSP) team in the surgical intensive care unit reported a high number of adverse events. In response to this issue, the Lifeline intrahospital transport service was established in 2002, as an extension of the existing patient transport system, using a similar model that was already in place for ground and air transport (Kue et al, 2011).
Literature Review: Patients are often left unattended or under nonclinical care at testing sites, in which issues can arise such as neurological deterioration, dislodgment of tubes or lines, loss of definitive airway, patient discomfort from transport and procedural positioning, unstable arrhythmias, and I.V. fluid or medication events (Sturm et al., 2012). “Typically, the interfacility transport decision is left to the discretion of the referring provider, who may or may not be aware of the level of care provided or the means of transport available” (Swickard et al., 2014). Kue et al.’s (2011) report was the first reported study to describe a system that uses a full-time, dedicated transport team. The only other hospital system known to have an intrahospital transport service is University of Michigan Medical Center in Ann Arbor (UMHS). Similar to JHH’s Lifeline intrahospital transport team, UMHS’s Specialized Workforce for Acute Transport (SWAT) team’s mission is to provide safe, respectful, and expert short-term care and treatment to patients and families during intrahospital transport to diagnostic and procedural areas and during bedside procedures (Sturm et al., 2012).
Implementation Methods: JHH created the additional intrahospital transport service, using the Lifeline systems that were already in place for transport. HAL, Hopkins Access Line, receives a call from the referring physician. They obtain patient demographic information, connect the referring physician with the appropriate service, and notifies Hopcom, the 24/7 emergency communications center, providing clinical and operational support for real-time issues. Hopcom dispatches the appropriate transport service- air, ground, or in house. The intrahospital service covers Level III and IV, Emergency, and HAT (Heart Attack Team) transports. In a typical day, they conduct 32 in house and two emergency RRT (Rapid Response Team)/Code transports, not to mention the many standby situations. All Lifeline employees, known as the ‘purple people’ wear purple scrubs for easy identification. Level III teams consist of an Emergency Medical Technician (EMT), and a paramedic. For Level IV’s, the addition of a registered nurse is required. There are strict pre-requisites to become an employee of Lifeline, and initial and routine training continues for each team member. After witnessing several transports in all modes, it is very clear their focus is the patient’s safety and comfort. The Lifeline professionals have well rehearsed systematic procedures and a teamwork approach, regardless of area of expertise, creating a seamless transition for the patient at all stages of the process. .
Results: The rate of clinically adverse events with the use of Lifeline’s intrahospital transport service was not only low, but also significantly lower than in other reported studies. The reported rate is between 6-70% for adverse events, as high as 8% for clinically adverse events (Kue et al., 2011). Kue et al.’s (2011) study of 3383 charts, and of those 91.8% completed transports, the overall rate of clinically adverse events was 1.7%. During 2013, there was only one clinically adverse event, resulting in the rate of .7%. See Table 1 for the utilization rates by unit for 2013. Since most clinicians are caring for more than one patient, the assistance of the transport team allows them remain on wards to care for their other patients and not be concerned with finding intermediate coverage while they are away for 30-60 minutes or more, escorting the patient to receive critical tests or procedures. In addition, since most clinicians are not equipped with the skills or logistics for transporting a critically ill patient, because they do not do this routinely, having a specialized team for these situations significantly reduces the risk factors.
Conclusion: Patient safety and decreasing risks in transporting critically ill patients is very challenging and a delicate process. Using this successful model from a world-renowned medical center, hospitals can adopt and provide similar services in order to increase patient safety and satisfaction, save time, and decrease other life threatening factors associated with transporting high-risk patients, among many other positive returns on investment.
Table 1.
References
Kue, R., Brown, P., Ness, C., & Scheulen, J. (2011). Adverse Clinical Events During
Intrahospital Transport by a Specialized Team: A Preliminary Report.American Journal of Critical Care, 20(2), 153-162.
Sturm, J., Mitchell, A., & King, L. (2012).SWAT nursing: A unique specialty. American Nurse
Today, Retrieved February 11, 2014 from
Swickard, S., Swickard, W., Reimer, A., Lindell, D., & Winkelman, C. (2014) Adaptation of
the AACN Synergy Model for Patient Care Transport. Critical Care Nurse. The Journal for High Acuity, Progressive, and Critical Care Nursing, 34(1), 16-2.