Swickard, Scott W.
Patient Safety Events During Critical Care Transport.
Degree: PhD, Nursing, 2016, Case Western Reserve University School of Graduate Studies
Purpose StatementThe purpose of this retrospective
chart review was to investigate the type and frequency of patient
safety events (PSE) during critical care transport (CCT) between
hospitals and explore the patient characteristics, nursing
competencies, and environmental factors impact on PSE. Research
QuestionsResearch questions were:1.What are the types and
frequencies of patient safety events that occur when registered
nurses (RNs) and advanced practice nurses (APNs) are lead
clinicians in ground, rotor and fixed-wing vehicles? 2.What is the
impact of the patient characteristics of stability, vulnerability,
complexity, predictability, and resiliency on frequency of patient
safety events?3.Do the nursing competencies of caring practices and
clinical judgment, have a mediating or moderating role on the
frequency PSE?4.Do modifiable environmental factors (i.e., time
outside of the ICU and mode of transport) influence the frequency
of PSE?MethodThis was a descriptive, comparative review of 5 months
of records at a quaternary academic medical center. Inclusion
criteria were all inter-hospital transports via ground, rotor, and
fixed wing transport. Cases with PSE reported were compared to
randomly selected non-PSE cases (ratio 1 PSE: 8 non-PSE cases).
Logistic regression was used to determine relationships among the
variables of interest with the occurrence of PSE.ResultsThe rate of
PSE was 2.65% among all qualifying cases. A total of 440 cases were
reviewed and entered into the database (48 with PSE: 392 without
PSE). Adverse events were the most common type of PSE (1.88%), and
new or recurrent hypoxia was the most frequent type of adverse
event. The patient characteristic of stability was significant
(p=0.083, OR 1.059, 95% CI 0.993-1.113). Secondary analyses
supported the association of hypoxia, a component of stability,
with PSE. The nursing competency of clinical judgment, as measured
by experience in years of transport employment of the lead
clinician, was identified as a potential moderator of
hypoxia-related PSE. Duration of transport demonstrated the most
consistent relationship with PSE in secondary analysis.Conclusion
Hypoxia, defined as new or recurrent decrements in peripheral
oxygenation, emerged as a new consideration for evaluating patients
risk for CCT PSE.
Advisors/Committee Members: Winkelman, Chris (Committee Chair).
Subjects/Keywords: Nursing; Patient Safety Events; critical care transport; inter-facility transport
…expansion in inter-facility transport in recent years. The majority of CCT is
between hospitals… …used during
inter-facility transport. They found patient safety event rates decreased from 34… …intra-transport
patient safety events during inter-facility transport. Singh and colleagues… …patient in need of inter-facility transport by a defined CCT team in which the
initiation or… …defined
as the inter-facility transport of a patient using surface transport vehicles (i.e…
to Zotero / EndNote / Reference
APA (6th Edition):
Swickard, S. W. (2016). Patient Safety Events During Critical Care Transport. (Doctoral Dissertation). Case Western Reserve University School of Graduate Studies. Retrieved from http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671
Chicago Manual of Style (16th Edition):
Swickard, Scott W. “Patient Safety Events During Critical Care Transport.” 2016. Doctoral Dissertation, Case Western Reserve University School of Graduate Studies. Accessed October 27, 2020.
MLA Handbook (7th Edition):
Swickard, Scott W. “Patient Safety Events During Critical Care Transport.” 2016. Web. 27 Oct 2020.
Swickard SW. Patient Safety Events During Critical Care Transport. [Internet] [Doctoral dissertation]. Case Western Reserve University School of Graduate Studies; 2016. [cited 2020 Oct 27].
Available from: http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671.
Council of Science Editors:
Swickard SW. Patient Safety Events During Critical Care Transport. [Doctoral Dissertation]. Case Western Reserve University School of Graduate Studies; 2016. Available from: http://rave.ohiolink.edu/etdc/view?acc_num=case1468431671