on the basis of data collection of life saving patient transfer to higher center, we found that...
TRANSCRIPT
Find an Opportunity for Improvement
Organize a Team
Clarify Current Process
Select Desired Outcome
PLAN THE PROJECT
DO THE WORK THAT IS NEEDED
CHECK THE RESULTS
Nursing Department , Aflaj General HospitalIMPROVE TRANSFER TIME FOR LIFE SAVING PATIENT TO
HIGHER CENTER Performance Improvement Project
On the basis of data Collection of life saving patient transfer to higher center , we found that about 53.19% of patient were transferred more than one hour and sometimes reached to 7 hours and more. The delaying in transfer will decrease the prognosis of life threatening cases and patients' relatives always complaining and unsatisfied from the patient transfer management.
ACT TO MAINTAIN THE CHANGES
Leader Sis. Neama Ali Hassan (Nursing Director) Facilitator Mr. Eid Al Bakar (Quality Director)Members Dr. Muhammad Younus (Deputy Quality Director Sis. Anna Kristie Ledesma (Quality Coordinator) Sis Shiji K. Babu ( Quality nurse) Sis Pennama E.D ( Nsg. Supervisor ) Mr. Abdul Hamid (Biomedical engineer )
Understand the Current Problem
Flow chart for life saving transfer process
YES
YES
YES
Patient came inER in critical
condition
Accepted to transfer YES
Patient shifted to another hospital on time without delay
Arrange doctor/nurse anesthesia technician
Prepare the ambulance (checking ambulance for
ventilator , O2, pulse oximeter,and other medication
prepare patient for transfer ( investigation s, X-Rs, CTS,
U /S, police clearance , medical report
Fax reply for patient acceptance
Fax and medical report
Send fax and medical report to emergency coordination
Need transfer to higher center
Patient revived
Needs CPR
Assessment by treating physician
At least 30 minutes CPR
Human
MachineMaterial
Environment Method
Ambulance Driver Not availableNurse delaying in attendanceDoctor Delaying in attendancePatients' relative Not AvailableAnesthesia Technician: Delay in attendance
Ventilator No portable ventilator availablePulse Oximeter No battery Oxygen Cylinder No enough O2 cylinder O2 is not fullAmbulance Supplies are not enough
X-rays, CT,U/S Unavailable reportPolice Clearance Paper not availablePatients' I.D Not availableInvestigation reports Not available
Off duty hours so difficulty In communication all related people
Very crowded after duty hours with patient relative
Due to shortage to find escort specially nurses & very difficult to find doctors
Increase number of transfer due to increase number of RTA
Policy Policy and procedure not communicating well
Delayed Life Saving Patient Transfer to
Higher Center
Activity Responsibility Target Date Resource Outcome
1.Write clear policy for patient transfer Outside the hospital.
Nursing administration Quality Coordinator
One month(01-04-1433)
Policy approved from Hospital
Director
Smooth work process will develop
2.Write a clear policy for ambulance checking
Nursing administration Quality Coordinator
One month from(01-04-1433)
Policy approved from Hospital
Director
Improve teamwork. Smooth work process. Ambulance will be ready from mechanical and electrical side and also from biomedical and nursing side. patient will transfer on time.
3. Make schedule for escort nurses, physicians, anesthesia technician.
Nursing administration
Medical director
One monthFrom
) 01-04-1433(
Written escort team schedule &
Approved from hospital director
Prevent delayed physician and escort nurse.
4.Request enough portable ventilators & O2 cylinders
Nursing Director One monthFrom
( 04-03-1435)
Written request to hospital administration
It will prevent delaying patient transfer because machines and materials will be available.
5.Conduct educational session to all staff nurses about how to operate the ambulance & machines
Nursing educator Biomedical engineer
One monthFrom
( 04-03-1433)
-Ambulances - Medical equipments and machines
Easy operation of the ambulance and medical equipments will decrease delaying patient transfer.
6- Separate special drivers to be responsible to escort the ambulance only and free from other work
Hospital administration
Chief of drivers
One monthFrom
(04-03-1433 )
Witten request and approved by hospital administration
-The driver will be always available.-Patient will transfer on time and will not be delayed.
AVERAGE TIME NEEDED TO TRASFER THE PATIENT IN
THE YEAR 1433 ( FROM MONTH 4 – 12 )
Time of Transfer
Number of Patient %Rate
1 HOUR 22 46.801. 5 HOURS 2 4.25
2 HOURS 6 12.82.5 HOURS 3 6.383 HOURS 6 12.77
3.5 HOURS 4 8.514 HOURS 1 2.12
4.5 HOURS 1 2.125 HOURS 0 0
5.5 HOURS 0 06 HOURS 1 2.12
6.5 HOURS 0 07 HOURS 0 0
7.5 HOURS 1 2.12
AVERAGE TIME NEEDED TO TRASFER THE PATIENT IN
THE YEAR 1434
Time of Transfer
Number of Patient %Rate
1 HOUR 45 48.9%1. 5 HOURS 19 20.7%
2 HOURS 9 9.8%2.5 HOURS 10 10.9%3 HOURS 1 1.1%
3.5 HOURS 4 4.3%4 HOURS 1 1.1%
4.5 HOURS 0 0%5 HOURS 0 0%
5.5 HOURS 0 0%6 HOURS 0 0%
6.5 HOURS 1 1.1%7 HOURS 1 1.1%
7.5 HOURS 0 0%8 HOURS 0 0%
8.5 HOURS 0 0%9 HOURS 0 0%
9.5 HOURS 0 0%10 HOURS 1 1.1%
10.5 HOURS 0 0%
TRENDING REPORT OF IMPROVE TIME OF LIFE SAVING PATIENT TRANSFER FOR THE YEAR 1433 & 1434
Pareto Chart (Reason Of Delaying Life Saving Patient Transfer) Year 1434 & 1435
PROVE TIME OF LIFE SAVING PATIENT TRANSFER 1435 (MONTH 1-5 )
CURRENT ACTIONS:Achieve 72.2 % of life saving patients transferred to higher center
within one hour. Immediate response from the escort team .24 hours ambulances , emergency kit , medical equipments are
available & ready .Approved escort schedule for nurses & still physician to follow Avoid writing live saving fax before stabilization of the patient
and fax should be written after all necessary procedures done Request the police station clearance for patient transfer to other
hospitals in all RTA cases upon admission .24 Hours drivers are covering duty .
FUTURE PLAN:Continue the implementation of
strategic action plan and monitoring till we will reach to all critical patients transferred within one hour
Requesting enough staff . continue implementation of
patient transfer policy
No
AVERAGE TIME NEEDED TO TRASFER THE PATIENT IN
THE YEAR 1435 (MONTH 1-11)
Time of Transfer
Number of Patient %Rate
1 HOUR 57 72.20%1. 5 HOURS 10 12.70%
2 HOURS 5 6.3%2.5 HOURS 4 5.1%3 HOURS 2 2.5%
3.5 HOURS 0 04 HOURS 0 0
4.5 HOURS 0 05 HOURS 0 0
5.5 HOURS 1 1.3%6 HOURS 0 0
6.5 HOURS 0 07 HOURS 0 0
7.5 HOURS 0 08 HOURS 0 0
8.5 HOURS 0 09 HOURS 0 0
9.5 HOURS 0 010 HOURS 0 0
10.5 HOURS 0 0
0%
20%
40%
60%
80%
46.80%
4.25%
12.80%
6.38%
12.77% 8.51%
2.12%2.12%
0.00% 0.00%2.12%
0.00% 0.00% 2.12% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
48.9%
20.7%
9.8%10.9%
1.1%4.3%
1.1% 0.0% 0.0% 0.0% 0.0%1.1% 1.1%
0.0%0.0% 0.0% 0.0% 0.0%
1.1%
72.2%
12.7%
6.3% 5.1%
2.5%0.0% 0.0%
0.0% 0.0%1.3%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%0.0%
0.0%
1433 1434 1435
048
1216
0306090
149 8 8 6 4 4 2 2
Reason of delaying patient transfer Cumulative %
Decreased time to transfer of critically ill patients
Increased Prognosis