The Construction And Application Of Risk Management Program For Intrahospital Transport Of Critically Ill Patients In Emergency Department Based On 4R Crisis Management Theory

Objective: Under the background of prominent problems such as frequent adverse events,weak risk awareness of transport personnel,and lack of transport risk management process during intrahospital transport of critically ill patients,this study aimed to develop a risk management program for intrahospital transport of critically ill patients in the emergency department based on the 4R crisis management theory,which is a continuous,dynamic and interactive risk management theory.The risk management program was preliminarily applied to clinical practice to evaluate its effect,so as to early eliminate risk factors in the transport process of critically ill patients,reduce the incidence of adverse events,and maximize the safety of patient transport,providing reference for improving the clinical practice of intrahospital transport management of critically ill patients.Methods: This study was carried out in two stages: The first stage: Identification of risk factors.Based on systematic review,literature analysis and other methods,combined with the results of the cross-sectional investigation,the relevant literatures on adverse events of intrahospital transport of critically ill patients were analyzed and summarized,in order to identify the risk factors of adverse events during intrahospital transport of critically ill patients.The second stage: Program formulation and application research.Using the 4R crisis management theory,a systematic and comprehensive risk management program for intrahospital transport of critically ill patients in the emergency department was developed from the reduction stage,readiness stage,response stage and recovery stage,and applied it to the intrahospital transport process.Three months after implementation,the status quo of intrahospital transport of critically ill patients in the emergency department was investigated again.The incidence of adverse events,knowledge level of transport personnel and satisfaction degree of patients and their families before and after hospital transport were compared to evaluate the clinical effect of the program.Results: Stage I: To identify the risk factors for adverse events during intrahospital transport of critically ill patients.Nineteen literatures(2 cohort studies and 17 cross-sectional studies)involving 27 risk factors were included in the systematic review.Qualitative analysis was performed on 5 literatures and meta-analysis was performed on 14 literatures.There were 8207 intrahospital transports involving 7826 patients,of which 1980 were adverse events(24.13%).Meta-analysis results showed that: respiratory system diseases(OR=2.31,95%CI:1.57~3.39),neurological diseases(OR=0.58,95%CI:0.48~0.71),multiple organ failure(OR=1.98,95%CI:1.30~3.03),transport to the intensive care unit(OR=1.80,95%CI:1.22~2.65),and the use of vasoactive drugs before or during transport(OR=2.45,95%CI:1.51~3.95)were all related to the occurrence of adverse events of intrahospital transport in critically ill patients.From June to July 2021,it was investigated that the current situation of intrahospital transport of 136 critically ill patients in the emergency department of a tertiary grade A general hospital in Shanxi Province.Among them,40 cases(29.41%)had unexpected events during transport,15.44% of adverse events were clinical adverse events,and 13.97% of adverse events were non-clinical adverse events.The results of univariate analysis showed that transport destination,transport nurse’s working years,number of pipelines,oxygen supply device,MEWS score and transport time could affect the occurrence of adverse events in intrahospital transport of critically ill patients.Logistic regression analysis found that the main risk factors were the transport destination,transport nurse’s working years,oxygen supply device and MEWS score.Finally,based on literature research and expert meeting results,it was determined that the risk factors of intrahospital transport adverse events for critically ill patients included six aspects: environment(lack of space,unreasonable hospital setting,lack of humanized design of the environment and transport itinerary),organization management(unreasonable composition of transport personnel,unclear division of labor,unreasonable design of transfer process,poor connection of transfer links,lack of supervision of transfer team,emergency transport),equipment(ventilators,monitors,infusion pumps,injection pumps,portable aspirators,defibrillators battery depleted or equipment failure,insufficient oxygen),patients(inadequate preparation before transport,transfer condition was unstable,special treatment before and during transport,many pipeline,negative emotions,transport destination),transport personnel(lack of risk awareness,insufficient transfer experience,incomplete pre-transport assessment,inadequate equipment inspection,insufficient drug preparation,insufficient communication,untimely observation of illness,incorrect transport method,and long transport time),patient’s family(the patient’s families do not cooperate).Stage II: Application and evaluation of the risk management program based on 4R crisis management theory in the emergency department of intrahospital transport of critically ill patients.Based on the 4R crisis management theory,the risk management program of intrahospital transport of critically ill patients in emergency department was developed from four stages of reduction,readiness,response and recovery,and it was applied to clinical practice.The results indicated that the incidence of adverse events during intrahospital transport in critically ill patients in the intervention group was effectively reduced(12.10% vs.29.41%),and the satisfaction degree of patients and their families was improved(64.15 vs.57.42)compared with the control group.Before and after the implementation,the transport knowledge level of the transport personnel was also improved(46.59 vs.40.26),and the P value was statistically significant at less than 0.05.Conclusion: There were many risk factors for intrahospital transport of critically ill patients,included concomitant respiratory system diseases,multiple organ failure,high MEWS score,transport to the intensive care unit or examination room,special treatment before and during transport,lack of transport space,lack of risk awareness of transfer personnel,lack of experience and so on.They all threatened the transport safety of critically ill patients.Therefore,medical personnel should focus on the management and control of related risk factors to improve the safety of transport.The risk management program based on the 4R crisis management theory effectively compensated for the transport work through the personnel training,the elimination and prevention of risk factors before transport,the standardized crisis event handling plan and process during transfer,and the timely summary and reflection after transfer,significantly reduced the occurrence of unsafe events in the transport,and finally improved the emergency department transport work quality and transport safety.