Authors (including presenting author) :
Wong KW, Chiu SH, Hui YC, Wong LY
Affiliation :
Department of Cardiothoracic Surgery, Queen Mary Hospital
Introduction :
Intra-hospital transport (IHT) of critically ill patient is a complicated, risky and stressful procedure with adverse event rate ranging from 4.2% to 78.9% as highlighted in various studies. IHT associated adverse events will lengthen the ICU days, increase the morbimortality of ICU patients as well as the society healthcare expenses. During the first half year of 2019, more than 140 IHT events were recorded in QMH CTSD ICU with the major destinations of operation theatre and radiological department. As of July 2019, nurses with less than 3 years of ICU experience account for 37% (27 out of 73) of our frontline workforce. To ensure the safety of IHT events and relevant patient outcomes in our ICU, an enhancement program was implemented to suit the departmental needs.
Objectives :
1. To enhance the IHT knowledge, skills and decision-making ability of our nursing staff 2. To customize an organizational strategy to facilitate the acquisition of IHT competency in QMH CTSD ICU
Methodology :
The enhancement program comprised of didactic session and hands-on session. Multiple identical sessions were hosted in our ICU. To maximize the learning impact, each session was limited to 4-8 participants. The didactic session aimed at theoretical consolidation with the introduction of updated knowledge, literature recommendations and evidence. Several acronyms were synthesized and introduced to manage the complete episode of IHT events in a systematic manner. The hands-on session targeted on both the technical skills and non-technical skills enhancement by offering the opportunity of scenario-based transport experience. Participants were required to prepare an invasive ventilated full body manikin to the radiological department. Real time physiological responses were manipulated by the electronic simulator apps. To obtain feedback and assess the effectiveness of this program, evaluation bundle including pre-post program written assessment, survey and program evaluation form were deployed.
Result & Outcome :
7 identical program sessions were conducted from July to November 2019. Participants included 42 nurses, accounting for 57.5% of our frontline staff and 88.9% of junior nurses with less than 3 years of ICU experience. The 42 sets collected evaluation bundle revealed remarkable results of this program. Our participants’ IHT knowledge level increased significantly from pre-program assessment mean score 9.7±2.01(Scale 0-15) to post-program mean score 13.08±1.3, with significant level at p< 0.001 by two tailed t-test. Staff survey disclosed a 50-80% growth of confidence to undertake the leader role in the transport team, in addition to systematically organizing and categorizing the IHT event. This program depicted the fundamental of organizational strategy to satisfy the departmental needs of transport training, which was generally appreciated by our participants according to program evaluation. To conclude, the efficacy of this enhancement program was proven, and maintaining relevant sustainability is highly recommended.
