Patient safety incidents during interhospital transport of patients : a prospective analysis

Introduction: Interhospital transport of critically ill patients is at risk of complications. The objective of the study was to prospectively record patient safety incidents that occurred during interhospital transports and to determine their risk factors. Methods: We prospectively collected data during a fifteen-month period in 2 hospitals. Patient and transport characteristics were collected using a specifically designed tool. Patient safety incidents were appraised for health-care associated harm, and categorized as technical, operational, and communication problems. Results: Our study included 688 patients who were transferred to or from one of both hospitals by physician or nurse led transport, with complete records. A patient safety incident was reported in 16.7% of transports, health-care associated harm was noted in 3.9% of cases. In multivariate analysis, three factors remained significantly associated with an increased risk of healthcare-associated harm: operational incidents (odds ratio = 144.93, 95% CI = 37.55-767.50, P < 0.001), communication incidents (odds ratio = 11.05, 95% CI = 3.02-52.99, P < 0.001) and the Modified Sequential Organ Failure Assessment (M-SOFA) score (odds ratio = 1.198, 95% CI = 1.038-1.40, P = 0.017). Conclusions: The observed rate of patient safety incidents during interhospital transfers is lower than previously reported in the literature. However, there is limited previous work done on this topic. Operational and communication incidents, and a higher M-SOFA score are significantly associated with increase odds of harmful incident. These findings call for stricter preparation of transfers, with clear and standardized communication

2 2009 Expérience pilote PIT : mise en œuvre d’équipes infirmières dans 10 ambulances participant à l’aide médicale urgente en Belgique. Bilan au terme de la 2e année d’activité

peer reviewedL'article fait le bilan de l'expérience de moyens de secours à accompagnement infirmier sur base de deux ans de données d'intervention. Il conclut de l'analyse statistique que le temps d'intervention est réduit, que les actes posés sont comparables, et que la gestion de la douleur est améliorée

Stability of Drugs Used in Helicopter Air Medical Emergency Services: An Exploratory Study

Objective Transportation by air exposes drugs used in emergency medical services to vibrations. The aim of the study was to determine whether or not vibrations caused by a helicopter induce the degradation of 5 drugs used in this setting. Methods A longitudinal study in an operating medical helicopter along with a worst case was conducted. The studied drugs were 3 drugs labeled for refrigeration (cisatracurium, lorazepam, and succinylcholine) and 2 albumin solutions (human albumin 4% and 20%). These drugs were stored for 4 months according to the following conditions: inside a helicopter, worst case with exposure to extreme vibrations, at room temperature, and according to manufacturers’ recommendations. Samples were analyzed with validated high-performance liquid chromatography assay methods. A drug was considered stable if the remaining drug content was above 90% of the label claim. Except for the albumin solutions, visual inspection was used to determine instability by the formation of aggregates. Results Only the samples stored at room temperature became unstable after 4 months. No difference in extreme foaming was observed in the albumin solutions. Conclusions These data suggest that the effect of degradation of drugs caused by vibrations is negligible. Temperature was observed as the main cause of drug degradation. The impact of temperature exposure on drug deterioration during ground transportation for the delivery of emergency medical services (EMS) has already been studied in real-world settings.1, 2 and 3 However, no studies were performed thus far to determine the impact of vibrations on drug stability in ground or in air medical transportation. Although the underlying mechanism remains unclear, vibrations may affect drug stability as a result of the initial rise in temperature caused by energy expenditure or as a result of interactions with surfaces (eg, vial-water interfaces).4, 5 and 6 Previous studies showed that cisatracurium, lorazepam, and succinylcholine, when exposed to prehospital conditions, became unstable in a few weeks or months, suggesting that these might also be susceptible to vibrations.2 and 3 Cisatracurium and succinylcholine are both muscle relaxants and are used to assist endotracheal intubation. Lorazepam is used to treat status epilepticus. Furthermore, it is described that most proteins, including albumin solutions, form precipitates by adsorption to solid surfaces when sufficient agitation or shear forces are introduced.5 Albumin 4% and 20%, both albumin solutions, are used as fluid resuscitation in patients with sepsis. Vibration is inherent to all transport vehicles, but it has been shown that air transfers are characterized by higher frequencies and higher lateral (side to side) and anterior-posterior (chest to back) accelerations; however, these are considered as more stable vibrations compared with ground transportation.7 The aim of this study is to determine whether vibrations caused by helicopter transport results in the degradation of these 5 essential drugs used in helicopter emergency medical services (HEMS).publisher: Elsevier articletitle: Stability of Drugs Used in Helicopter Air Medical Emergency Services: An Exploratory Study journaltitle: Air Medical Journal articlelink: http://dx.doi.org/10.1016/j.amj.2016.02.001 content_type: article copyright: Copyright © 2016 Published by Air Medical Journal Associatesstatus: publishe

Optimal defibrillation strategy and follow-up of out-of-hospital cardiac arrest

In the current climate of rising healthcare cost, resuscitation efforts performed outside the hospital are critically evaluated because of their limited success rate in some settings. As part of a quality assurance program between the 1st January 1991 and 31st December 1993, six centres of the Belgian CPCR study group prospectively registered cardiac arrest (CA) patients and their treatment according to the Utstein Style recommendations. In the group (n = 511) of patients initially found in ventricular fibrillation (VF) a significantly better survival rate was observed for those patients who received a 1st defibrillatory shock by the 1st tier (n = 142 (27.8%)) as compared to those defibrillated after arrival of the 2nd tier (n = 369 (72.2%)). Median time to delivery of the first shock was significantly shorter (5 min) in the 1st tier group. In a second part of the study we describe long-term management of the 28 surviving VF patients, treated by the single EMS system of Brugge between 1st January 1991 and 30th April 1995: only 6 patients eventually received an implantable cardioverter defibrillator (ICD), whereas coronary revascularization was performed in 9 patients, and 3 patients were discharged on amiodarone only. Satisfactory long-term survival after out-of-hospital VF can be achieved by an early shock followed by advanced life support and appropriate definitive treatment.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

What did we learn from the time registration in the belgian cardio-pulmonary-cerebral resuscitation registry?

It is well known that in a case of cardiac arrest a fast intervention is essential for the survival of the victim. All research on resuscitation therefore contains some reference to intervention times. In the past it was difficult to compare the results of different studies. This problem has however been overcome by the publication of the Utstein Guidelines, as these guidelines emphasize on a correct and complete time registration with uniform definitions of the different time intervals. As the Belgian Cardio-Pulmonary-Cerebral Resuscitation Study Group tries to collect all these time intervals we are able to present the complete performance of the interventions for cardiac arrest of five registration centres and to identify weak points in our ‘chain of survival’. © 1996 Chapman and Hall.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Clinical status before and during cardiopulmonary resuscitation versus outcome in two consecutive databases

The outcome of out-of-hospital cardiac arrest is very much determined by uncontrollable precardiopulmonary resuscitation (CPR) conditions. Two consecutively registered databases containing variables related to pre-arrest, arrest and CPR are similarly analysed to produce and validate a simple clinical algorithm for acute decision making during CPR. The outcome results in the two different time periods remained nearly unchanged. The simultaneous and persistent absence of ventricular fibrillation, gasping and light-reactive pupils after arrival of the second tier was strongly associated with a poor outcome. Unresponsiveness of these variables to a full and optimal trial of advanced life support can in itself be considered as an index for irreversible myocardial and neurological damage. © 1995 Chapman & Hall.SCOPUS: ar.jinfo:eu-repo/semantics/publishe