Implementing an Automated Transport Stability Scale

Abstract

Background:

Intra-facility transport of patients is a common practice in most hospitals, UAB Hospital averages over 600 daily. The patient's acuity may range from low to critical; making the decision on who should transport patients is complicated and sometimes underappreciated. Low acuity patients may be transported by unlicensed transport personal, high acuity patients require an RT and an RN. Pre 2015 at UAB Hospital, the bedside RN was required to fill out a preprinted stability scale called a Paper Travel Tracker (PTT). If completed the PTT would help the RN determine who is needed to transport the patient. The decision should be based off patient's vital signs and current devices; ventilator, BPAP, HFNC, O₂ flow and FIO₂ (RN ≥ 0.40 and RT ≥ 0.60 or ≥ 10 L/min), and 'saturation instability' (Sat < 90% in last 24 h).

Methods:

In 2015 the Patient Safety Executive Committee created an interdisciplinary safety team that reviewed all PTTs of patients transported for 2 weeks to the radiology department. Only 16% of the PTT were completed and a review showed the RN recognized stability correctly at only 24% of the time, causing patients to be transported 76% of the time without a required RN/RT. After all RN re-education, the completed PTT went up to 25% with the RN recognizing stability correctly 24% of the time. The safety team developed an auto-generated Electronic Travel Tracker (ETT); data is pulled from the patient's EMR, look back is for 12-24 h or if devices are present (Vent, HFNC, ICP). The ETT clearly states who is required for the transport and why. As the ETT is printed a copy is saved in patient's EMR.

Results:

Five nursing areas conducted a 6-month feasibility trial using the ETT with 100% compliance and with 100% identifying the staff needed for transport. The 3 most frequent reasons for RN/RT transport was 'Increased FIO₂' at 15%, 'O₂ Saturation Instability' at 13%, and 'High Early Warning Scale' at 13%. The 5 pilot nursing units had 12 rapid responses team (RRT) activations the previous 6 months with the PTT and zero RRT activations and zero reported adverse events in procedural areas post-ETT implementation.

Conclusions:

Automated decision tools have advantages over manual tools; easier, faster, therefore more frequently obtained, and a higher identification of required staff needed for transport. This should result in a safer transport environment, decreased patient issues, and decreased RRT activations.

Disclosures:

None.