Critical Care Helicopter Overtriage: A Failure Mode and Effects Analysis.
Aged; Humans; Male; Adult; Female; Aged 80 and over; Middle Aged; Infant; Adolescent; Child; Emergency Medical Services; Young Adult; Child Preschool; Quality Improvement; Aircraft; Healthcare Failure Mode and Effect Analysis/methods; Triage/standards; Air Ambulances
OBJECTIVE: Overtriage (OT) of helicopter emergency medical services (HEMS) poses significant burden to multiple stakeholders. The project aims were to identify the following: 1) associated factors, 2) downstream effects, and 3) focus areas for change. METHODS: We undertook a failure mode and effects analysis (FMEA) to evaluate our HEMS interfacility transport process. Data were collected from organizational finances and 3 key stakeholder groups: 1) interfacility patients transferred by HEMS in 2017 who were discharged from the receiving facility within 24 hours (n = 149), 2) flight registered nurses (n = 19), and 3) referring emergency medicine providers (EMPs) (n = 30) from the top HEMS users of 2017. The completed FMEA identified failure modes, the frequency and severity of effects, and unique risk profile numbers (RPNs). RESULTS: Twelve failure modes were identified with 30 potential causes. Leading failure modes included inappropriate HEMS requests by EMPs (RPN = 343), inappropriate activation by EMS for interfacility transport (RPN = 343), and minimizing patient/family involvement in decision making (RPN = 315). Significant burdens to organizational finances and flight registered nurse satisfaction were identified. CONCLUSION: Associated factors for interfacility HEMS OT, downstream effects, and areas for change were identified. EMP and emergency medical services practices, HEMS processes, and shared decision making may affect regional OT rates.
Grabowski RL; McNett M; Ackerman MH; Schubert C; Mion LC
Air Medical Journal
2019
2019-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.amj.2019.07.012" target="_blank" rel="noreferrer noopener">10.1016/j.amj.2019.07.012</a>
Temperature-sensitive Medications in Interfacility Transport: The Ice Pack Myth.
*Air Ambulances; *Pharmaceutical Preparations; *Point-of-Care Systems; *Temperature; Cold – Equipment and Supplies; Drug Storage/standards; Drugs; Emergency Medical Services; Refrigeration – Methods; Refrigeration/*methods/standards; Temperature; Time Factors; Transportation
INTRODUCTION: Critical Care Transport teams use various strategies to maintain temperature sensitive drugs and equipment at optimal temperature. The purpose of this study was to examine the effectiveness of current passive refrigeration of temperature sensitive transport medications/equipment. METHODS: Initially, we performed a retrospective review of transport durations. Subsequently, an experimental paradigm was created using a temperature probe inside of the transport cooler packs utilizing various configurations and initial starting temperatures with high and low "in range" temperature margins of 8 degrees C (max) and 2 degrees C (min). RESULTS: The mean round-trip transport time was 2.5 hours and over 15% of transports last longer than 4 hours. At a starting temperature of -3.9 degrees C, the cooler and ice pack maintained "in range" temperatures for 3 hours. When the ice pack starting temperature was -12.9 degrees C, high temperatures excursions weren't experienced until 6 hours 55 minutes, but initially low excursions fell below for up to 3 hours. iSTAT((R)) cartridges remained within range between 1-4 hours at cooler and ice pack starting temperature of -3.9 degrees C. CONCLUSION: The current system of passive refrigeration does not appear to be sufficient for safely storing medications or point-of-care testing equipment for our transport services. This might reveal a flaw in the existing practices around medication refrigeration in transport.
Clancy Jason; Karish Cassandra; Roddy Meghan; Sicilia Judith J; Bigham Michael T
Air medical journal
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.amj.2017.05.002" target="_blank" rel="noreferrer noopener">10.1016/j.amj.2017.05.002</a>