Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients

doi:10.1016/j.jpedsurg.2011.10.030

Journal of Pediatric Surgery

Volume 47, Issue 1, January 2012, Pages 112-118

https://doi.org/10.1016/j.jpedsurg.2011.10.030 Get rights and content

Abstract

Background

Intrahospital transfers are necessary but hazardous aspects of pediatric surgical care. Plan-Do-Study-Act processes identify risks during hospitalization and improve care systems and patient safety.

Methods

A multidisciplinary team developed a checklist that documented patient data and handoffs for all intrahospital transfers involving pediatric surgical inpatients. The checklist summarized major clinical events and provided concurrent summaries by 3-month quarters (Q) over 1 year.

Results

There were 903 intrahospital transfers involving 583 inpatients undergoing surgery. Total handoffs were documented in 436 (75% of 583), with greater than 1 handoff in 202 (46% of 436). Documented problems occurred in 31 transfers (3.4%), the most during Q1 (19/191; 9.9%). Incidence fell to 3.5% (9/260) in Q2, 0.4% (1/243) in Q3, and 1.0% (2/209) in Q4 (P < .001). Patient care issues (14/31; 45%) were most common, followed by documentation (10, 32%) and process problems (7, 23%). The quality improvement team was able to resolve patient instability during transport (5 in Q1, none in Q3, Q4) and poor pain control (3 in Q2, 1 in Q3, Q4). Of the patients, 3.2% had identified problems with patient care during intrahospital transfer.

Conclusions

Plan-Do-Study-Act review emphasizes ongoing process analysis by multidisciplinary teams. Checklists reinforce communication and provide feedback on whether system goals are being achieved.

Section snippets

The pediatric QI team

In April 2008, a group met to organize a pediatric surgical program at the Medical Center of Central Georgia, a 518-bed tertiary referral community hospital in Macon, GA. A multidisciplinary QI team included (a) representatives from hospital administration to provide system leadership, (b) pediatric specialty surgeons and anesthesiologists to give clinical technical expertise, and (c) nurse leaders from the OR, PACU, anesthesia department, and inpatient and critical care areas to drive the

Results

There were 903 documented intrahospital transfers on the service, including those going to the OR (Table 2). The pediatric surgery service had 583 inpatients undergoing surgery during the period of review. We identified patient care areas at the time of surgery in 444 (76%, 444/583): from the NICU in 103 (23% of 444); PICU, 21 (5%); ED, 1 (1%); and the general pediatric ward, 318 (72%). We were able to document the numbers of handoffs of care with each intrahospital transfer in 436 episodes

Discussion

Our multidisciplinary pediatric surgery QI team used the PDSA process and the intrahospital checklist to identify and resolve major patient care and process of care issues within 20 months of its implementation (April 2008 to November 2009). Over a 12-month period of review (December 2008 to November 2009), the QI process documented significant improvements in issues such as transport of unstable patients, postoperative pain control, H & P and consents for operation, and timely transfer. Each

Acknowledgments

The authors would like to acknowledge Timothy M. Grant, MD; Amanda Brown, MD; Dawn Cole, RN; Irene Hubbard, RN, BSN, MHA; Timothy N. Bushey, RN, BSN, MSN; Cyndee Adams, RN; Rebecca Cogburn, RN; Suzanne Garvin, RN; Aimee Lowery, RN; and the members of the pediatric QI team at the Medical Center of Central Georgia, Macon. We also thank the members of the pediatric nursing staff at the hospital for their dedication to the project and the care and devotion to the pediatric surgical patients, the

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APSA paperQuality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients

Abstract

Background

Methods

Results

Conclusions

Section snippets

The pediatric QI team

Results

Discussion

Acknowledgments

Crit Care Clin

AORNJ

Intensive Crit Care Nurs

Jt Comm J Qual Patient Saf

J Surg Edu

High-risk intrahospital transport of critically ill patients: safety and outcome of the necessary “road trip"

Crit Care Med

Intrahospital transport of critically ill pediatric patients

Crit Care Med

Intrahospital transport of critically ill children—should we pay attention?

Crit Care Med

The critical care cascade: a systems approach

Curr Opin Crit Care

APSA paper
Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients