Introduction: Critically ill children frequently require intrahospital transport (IHT) for diagnostic or therapeutic interventions. IHT of critical patients introduces numerous variables that increase risk for adverse events (AEs) that are often identified as preventable. Standardized communication in the context of IHT of critically ill children has been shown to improve patient outcomes. We hypothesize that standardized multidisciplinary communication will reduce the number of IHT-related AEs at our institution. Methods: The global aim of our project is to reduce the frequency of AEs during IHT. Our SMART aim is to reduce preventable AEs by 50% within 12 months of implementation. Using standard QI methodology in collaboration with key stakeholders, we developed and implemented a multidisciplinary communication tool to mitigate the risk of IHT in our 44-bed medical-surgical pediatric ICU. This tool consists of three phases: patient screening, pre-transport huddle, and post-transport debrief. Data for IHT-related AEs is captured during the structured debrief. Baseline data was collected from 107 transports over 18 weeks. Initial post-implementation data was collected from 54 trips over 8 weeks. We evaluated utilization of the checklist and its effectiveness in reducing the number of IHT-related AEs, AEs requiring intervention, and total duration of transport. Results: Baseline IHT AE rate was 58 events per 100 transports and a preventable AE rate of 39. Ventilated patients had a higher rate of AEs at 88, with a preventable AE rate of 66. The most frequent AEs included endotracheal tube (ETT) displacement (12%) and inadequate sedation (9%). Post-implementation utilization of the patient screening was 46% and utilization of pre-transport huddle was 89%. With use of the pre-transport huddle, the rate of preventable AEs for all patients improved with a 36% reduction from baseline to 25 events (p=0.0483) and 42% reduction for ventilated patients to 38 events (p=0.0001). Conclusions: To date, the use of the pre-transport huddle has been associated with a statistically significant reduction in the rate of preventable AEs associated with IHT. Future PDSA cycles will focus on improved utilization of the pre-transport screening and focused QI efforts to reduce ventilator and ETT-related adverse events.
Brougher et al. (Sun,) studied this question.