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Is There Risk?

In this step, Dr Arndt Melzer and Dr Anthony O'Dwyer explain the risks of transfer and group them into four categories

Every transfer poses a risk to the patient and the staff accompanying them. In this video, we explore one way of understanding, identifying and classifying the types of risks that exist within transfer medicine.

Incidence Of Adverse Events

  • We heard in the presentation that one large-scale study found an incidence of 78% for any adverse event in a patient transfer with 91% being preventable [1].
  • A smaller Belgian study, by contrast, found that 16.7% of ‘patient safety incidents’ with ‘health-care associated harm’ in 3.9% cases [2].
  • A more recent meta-analysis published in 2021 suggested a low prevalence of adverse medical events, at around 11% [3] [4].
Inter-hospital transfer of critically unwell patients occurs in a dynamic environment and you and your team is the only protection your patient will have against deterioration
  • The reduction in incidents might be due to transfer teams becoming better trained and specialised. However, robust data on the incidence of these events is sparse and much of the research is retrospective and describes a heterogeneous group of patients in different healthcare systems making it difficult to compare.
  • Whatever the true numbers are, the fact remains that as transfer professionals we must regularly aim to prevent any and all adverse events from from happening.

Some Specific Examples…

Vehicle Failure & Accidents

  • Whilst modern technologies mitigate against many of the risks posed by vehicle failure and weather conditions, accidents remain a reality.
  • Published rates from Germany, Australia, and the USA have fatal accident rates per 10 000 missions ranging between 0.04 and 0.23 [5].
  • An Australian study calculated 5 accidents per 100 000 flight hours with a road ambulance accident rate of around 55 accidents per 100 000 transports [6].

Patient Deterioration

  • Transferring a critically unwell patient creates a stressful environment and exerts many potential effects which can cause physiological deterioration. It’s therefore exceedingly important to anticipate the risk of patient deterioration due to an adverse medical event during transfer.
An adverse medical event can be defined as any deterioration in a patient’s condition that results in an escalation in monitoring or intervention, and in recent meta-analysis this definition included a systolic BP < 90mmHg, SpO2 < 89%, a drop in GCS of > 2 points, respiratory distress and cardiac arrest
  • Rates of serious, inter-hospital adverse events are relatively low as are rates of CPR during inter-hospital transport: 0.68% and 0.18% in the adult and paediatric population, respectively [1] – [12]

Equipment Failure

  • One Australian study highlighted that adverse events were most commonly related to equipment directly involved in patient care.
  • Often we rely on the safety, design, longevity and sturdiness of the medical equipment we use to care for patients. With critically unwell patients there are typically many pieces of kit in use and each carry a risk of failure accounting for the most common source of adverse events. We’ll learn more about this in Week 3.
In the video above we’ve presented one way of classifying risks to patients and staff – but you may have your own. The important thing is to have a system and appreciate the risks unique to your patient and your transfer

References

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A Journey Through Transfer Medicine

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