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Risk events during intrahospital transport of patients from the emergency department: a prospective observational study
  1. Tom Neal-Williams1,
  2. Kimberly Walker2,
  3. Travis Lines3,
  4. Antony Ugoni4,
  5. David McDonald Taylor5
  1. 1 Nothern Health, Epping, Victoria, Australia
  2. 2 Western Health, Footscray, Victoria, Australia
  3. 3 Alfred Health, Prahran, Victoria, Australia
  4. 4 Department of Epidemiology and Biostatistics, University of Melbourne, Parkville, Victoria, Australia
  5. 5 Department of Emergency, Austin Health, Heidelberg, Victoria, Australia
  1. Correspondence to Professor David McDonald Taylor, Department of Emergency, Austin Health, Heidelberg, VIC 3084, Australia; dmcdtaylor{at}gmail.com

Abstract

Background We aimed to determine the incidence, nature of and predisposing factors for risk events (REs) that occur during the intrahospital transport of patients from the ED.

Methods We undertook a prospective, observational study of intrahospital patient transports from a single ED between 30 January and 20 March 2020. An investigator attended each transport and recorded any RE on a specifically designed data collection document. An RE was any mishap, even if not foreseen, that had the potential to cause the patient harm. A patient equipment number was assigned based on the number of pieces of equipment required during the transport. Poisson regression generated incidence rate ratios (IRRs) and determined risk factors for REs.

Results Of 738 transports, 289 (39.1%, 95% CI 35.6% to 42.8%) had at least one RE. The total of 521 REs comprised 125 patient-related, 279 device-related and 117 line/catheter-related REs. The most common included trolley collisions (n=142), intravenous fluid line catching/tangling (n=93), agitation/aggression events (n=31) and cardiac monitoring issues (n=31). Thirty-four (6.5%) REs resulted in an undesirable patient outcome, most commonly distress and pain. Predisposing factors for REs included an equipment number ≥3 (IRR 5.68, 95% CI 3.95 to 8.17), transport to a general ward (IRR 2.68, 95% CI 2.12 to 3.39), hypertension (IRR 1.93, 95% CI 1.07 to 3.50), an abnormal temperature and a GCS<14.

Conclusions REs are common in transport of patients from the ED and can result in undesirable patient outcomes. Adequate pre-transfer preparation, especially securing equipment and lines, would result in a reduced risk.

  • emergency department
  • performance improvement
  • risk management
  • safety

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Caroline Leech

  • Contributors DMT and TN-W conceived the concept and design of the study. DMT and TN-W wrote the ethics committee (IRB) application. DMT supervised the study overall. TN-W, KW and TL contributed to data collection and validation. TN-W managed collation of the data and entry into the study database. DMT and AU undertook the data analysis. All authors contributed to interpretation of the results, drafting and revision of the manuscript and take responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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