Failure mode and effect analysis in interhospital transport of critically ill patients: a tool to design checklists for handovers in the mobile intensive care unit

Introduction

The complex interhospital transport of critically ill patients bears multiple risks for patient safety, including handovers and reliance on mobile medical equipment. The hypothesis of the present study was that multiple handovers of both equipment and patients in critical care transport would demonstrate omissions and a failure mode and effect analysis (FMEA) would unravel its safety priorities.

Methods

FMEA of the process of interhospital ground critical care transport in the Amsterdam region was performed by three clinical experts to estimate failures in handovers of patients and equipment.

Deviations of the optimal process were documented by observations of 16 transports. A questionnaire was used to evaluate the multiple handovers of these transports by the escorting critical care registered nurses and intensivists and included attitude evaluation towards future structured checklists.

Results

The FMEA revealed that the highest risk priority numbers (above 45) were all related to the medical equipment control before start of transport. During transport observations the most frequent deviations in the process were related to omission of the defibrillator equipment check before transport (in nine out of 16 transports, 56%), handover of medication dose (25 of 39 syringe pumps, 64%) and location of infusion lines (39 of 54 lines, 72%). Nurses and intensivists demonstrated a positive attitude towards implementing handover checklists to improve the quality of the transport (29 of 34 respondents, 85%).

Conclusions

FMEA seems an applicable tool for risk assessment in critical care. The safety of interhospital critical care transport seems to be suboptimal by lack of standardized handovers. The check of medical equipment should have the highest priority in the optimization of safety in critical care transport. Handovers of information in critical care transport could possibly benefit from checklists.