By Halley Herndon, RN, Senior Clinical Consultant, Philips Capsule
Twitter: @capsule_tech
As an emergency nurse, I can attest that patient transports of critically ill patients can be stressful.
Every clinician on a transport is aware that unexpected events could occur in an elevator or hallway, even if the destination is only a few minutes away. Most transports, thankfully, go without incident. But, in those instances when adverse events do occur, stress levels elevate, as each passing second holds heightened importance in the wellbeing of the patient. Everyone involved in that transport, typically two nurses, and perhaps a respiratory therapist addresses the immediate medical emergency to stabilize the patient.
During these intense moments, if we can spare a second, we scribble down the patient’s vital signs data on any nearby sheet of paper, the bed sheets, or our scrubs so we can inform clinicians at the next location.
That means sometimes data from monitoring devices used during transport is typically lost because the devices were not connected to the network and the associated downstream systems. If the patient is stabilized and able to continue to the next care location, the transport information is then typically incomplete because nurses were understandably more focused on saving a patient’s life.
Yet automatically capturing that monitoring data during transport is possible and can be utilized to ease the nurses’ burden and help clinicians at the next care location deliver continued care. Vital signs data from transports can also help researchers determine what happened to the patient and if such events could be prevented in future transports.
Expect the Unexpected
Unexpected or adverse events during transport are infrequent, but not uncommon. A university hospital study of 262 intra-facility transports, for example, found 26% had an adverse event affecting the critically ill patient, and in 17% of those transports, the adverse event was considered serious, such as oxygen desaturation and hemodynamic instability. A smaller audit of transports from another medical center found 44% of transfers resulted in an incident.
If an event does occur, nurses will stabilize enroute, and the patient will likely need additional interventional care upon arrival. Data lacking from the transport means an incomplete record, resulting in less informed decisions at the next care location. That is part of the reason why, according to a 2017 survey, 78% of physician leaders say incomplete data on patients is the biggest threat to their welfare, while 97% of nurses say having a gap-free patient monitoring data record is essential for good patient care.
Similarly, in a study of EHR users across the hospital, providers working on general medical/surgical departments reported that the highest perceived safety risks associated with the EHR (aside from a system shutdown) were “failure to find or use the most recent patient data” and “incomplete or missing patient data.”
A Gapless Record
Real-time monitoring device data capture into the electronic health record (EHR) and other downstream systems during transport alleviates clinicians from needing to remember and manually input relevant vital signs that occurred, which can be challenging even on uncomplicated transports.
Automated data capture enables a smooth handoff to the next care location where a new care team assumes management. Researchers found after interviewing 49 nurses about transports between the emergency department and the inpatient department that ensuring “continuity of information” between the two teams was one of the most common challenges. Similarly, a random sample of 107 handoffs between the emergency department and the inpatient units found 30% of these transports had defective communication, with authors citing inaccurate or incomplete data as one of the top causes of the communication breakdown.
Improving communication means ensuring clinicians at the next care location have a complete and accurate picture of the patient to support safe decisions and prevent errors.
A complete record also supports meaningful research. The first of six questions clinicians conducting research should ask themselves is: “How complete are the data?,” according to a consensus published by a large, international group of experts from 29 medical schools, hospitals and other institutions, including Harvard University, University of Pennsylvania, University of Toronto, Centre de Recherche des Cordeliers in Paris, University Magna Graecia of Catanzaro in Italy, National University of Singapore, and many others. When the patient’s record includes multiple data gaps during transports, it could make that patient ineligible for a study.
Easing Documentation Burden
Although a patient’s health and safety come first, documenting relevant patient monitoring device data during transport is, nonetheless, a challenge for nurses and can contribute to feelings of burnout. Nurses even refer to intrahospital transports of critically ill patients to another department as “a marathon race” due to the stress of what could happen between care locations.
That is why hospitals worldwide utilize medical device integration (MDI) technology that automatically captures and timestamps monitoring device data during the transport to ensure that data is not lost or misremembered. At the next care location, or when reconnected with the hospital network, that data is uploaded to the EHR and downstream systems.
Freeing nurses and other clinicians from manually capturing and reporting the monitoring data can reduce some of their stress while allowing the transport team to maintain a greater focus on the patient instead of documentation, which can enable safe and effective transports and handoffs.