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Scottish Audit of Inter-Hospital Transfers of Acutely Ill Adults Nov 2007 – March 2008

Scottish Audit of Inter-Hospital Transfers of Acutely Ill Adults Nov 2007 – March 2008. Jean Bruce ~ Audit Coordinator Robert Colquhoun ~ Audit Assistant, SAS Mike Fried ~ Clinical Lead Daren Mochrie ~ IHT Board Manager, SAS George Smith ~ Database Management. Content. Context

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Scottish Audit of Inter-Hospital Transfers of Acutely Ill Adults Nov 2007 – March 2008

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  1. Scottish Audit of Inter-Hospital Transfers of Acutely Ill Adults Nov 2007 – March 2008 Jean Bruce ~ Audit Coordinator Robert Colquhoun ~ Audit Assistant, SAS Mike Fried ~ Clinical Lead Daren Mochrie ~ IHT Board Manager, SAS George Smith ~ Database Management

  2. Content • Context • Introduction • Methodology • Results • Conclusions • Recommendations

  3. Background Inter Hospital Transport (IHT) of patients is an integral part of routine healthcare delivery. IHT occurs for the following reasons: Requirement for specialist investigation / imaging Requirement for specialist management Lack of critical care facilities in referring hospital Inadequate number of staffed critical care beds Repatriation 78,000 IHTs per annum – 2006-07

  4. Introduction Aims Identify the number of acutely ill adult patients who are being transported between hospitals by Scottish Ambulance Service front line vehicles Assess the process of transportation and quantify the incidence of adverse events (audit) Establish the absolute number of adult IHTs during audit period (EIS data)

  5. Methodology • Design • Audit ran for 20 weeks (12th Nov 07 to 30th Mar 08) • Initially planned for Critically Ill Adults but:…….. • Audit all IHT activity - impractical • Final decision to collect data on “acutely ill adults”“Patient requires paramedic/technician intervention and recording of vital signs en route OR where the transfer has a doctor/nurse escort present.” • Caldicott Guardians contacted re data protection • Lothian Ethics committee

  6. Database and Data Entry • Customised database designed around audit form • Frequent upgrades as demanded by user • Subsidiary sections from EIS supplied • Call date and time • Station • Verifies male/female, Date of Birth • Allowed cross referencing to ensure accuracy of data • Created associated tables for stations, SAS Divisions, hospital departments, hospital health board regions • Additional reports generated to identify missing/suspect data

  7. Results Received 3048 audit forms 652 were excluded from results No monitoring and no escort Children <16 years Pick up home address Total 2396 included

  8. Type of Transfer • Emergency 493 (20.5%) • Urgent 1741 (72.7%) • Planned 162 (6.8%)

  9. Call Times to SAS

  10. Type of Transfer by Day of Week

  11. Patient Journey Times (hr:mins)

  12. Reg. Nurse415 Midwife83 ODP15 CSW 1 Aux. Nurse17 Student Nurse9 Consultant69 FTSTA 6 ST3 – ST5 22 ST1 – ST2 64 GPST 2 FY1 – FY2 22 Medical Student 3 Escort Summary Translator1 Other 3 Prison Officers 1 EMRS13 Shock Team192 825 (34.4%) of audited IHTs were escorted

  13. Escort Times (hr:mins) Median transfer times ~ 2:00 (min 00:05 max 17:33) Consultants 2:30 FTSTA 3:13 ST1-ST2 2:17 Reg. Nurse 2:28 Some escorts 12 - 14 hours if flight back

  14. Transfer Reasons by Health Board

  15. Transfers by Health Board

  16. SAS front line trolley v CCT6

  17. CCT 6 Trolley during audit

  18. Critical Department Transfers(ITU, CCU, HDU) • 540 transfers into departments • 411 transfers out of departments • 248 ventilated patients

  19. Critical Department Transfers Does not included A&E to A&E(n=9), A&E to Cath Lab (n=1)

  20. Ventilated Patient Journey Time NHS Health Board Count Median Minimum Maximum Ayrshire and Arran 7 00:30 00:25 01:15 Borders 1 00:46 00:46 00:46 Dumfries and Galloway 10 01:24 00:55 02:10 Fife 9 00:18 00:04 00:44 Forth Valley 3 00:39 00:36 00:40 Glasgow & Clyde 137 00:20 00:05 02:45 Grampian 20 01:15 00:07 01:40 Highland 11 01:00 00:25 02:05 Lanarkshire 21 00:30 00:15 01:20 Lothian 20 00:25 00:13 01:17 Shetland 1 02:55 02:55 02:55 Tayside 4 00:57 00:24 01:10 Western Isles 4 02:00 01:55 02:45 Scotland Total 248 00:28 00:04 02:55 Q1 0:17 Q3 0:50

  21. Reg. Nurse41 Student Nurse1 ODP8 Consultants 46 FTSTA2 SPR5 2 ST3 – ST5 13 ST1 – ST2 20 FY1 – FY26 Medical student 1 Escort Summary ~ Ventilated Patients EMRS 5 Shock Team 162 248 ventilated patient transfers (10.3% of audited IHTs)

  22. Escort Comments ~ return journey • “not authorised to get a taxi back. Carrying equipment on a bus extremely difficult. Ridiculous expecting staff to go on a shuttle bus as well as carry equipment. Took one hour to get back from Western to Royal” RIE to WGH - patient not ventilated • “abandoned in Govan at 1 am on a Friday night. SPR, nurse and equipment delayed in returning as crew sent to another job” WIG to SG

  23. Escort Return Modes ~ ventilated transfersnot including Shock Team or EMRS

  24. Clinical and Adverse Events • Unsecured equipment in escorted patients (excluding Shock Team and EMRS) = 113/620 (18.2%) • Clinical events requiring Rx = 84/2396 (3.5%) • cardiac arrhythmias, hypo/hypertension, desaturation • Adverse events 29/2396 (1.2%) • Adverse events in escorted patients 22/825 (2.7%) • Saturation monitor, infusion pump and 4 ventilator failures • ET tube displacement (n=1)

  25. Shock Team • Shock team transfers 192 – within audit criteria • Specialist care 92 • Lack of beds 88 • Repatriation 4 • Specialist Inv 3 • Lack of nurses 3

  26. Emergency Medical Retrieval Service (EMRS) • EMRS 13 – within audit criteria • Specialist Care 11 • Specialist Inv 2

  27. Shock & EMRS Away Time Time calculated from “leaving base” to “arriving back to base”

  28. Ventilated Patient transfer by Health Board

  29. Total IHT transfers within audit period

  30. 19,266 of which 17,877 were adults All conveyed by A&E vehicles (average of 894 adults per week) Total IHT transfers within audit period

  31. Edinburgh EMDC ~ top twenty

  32. Inverness EMDC ~ top twenty

  33. Paisley EMDC ~ top 20

  34. IHTs across Scotland ~ top 10

  35. Conclusions from Audit Significant IHT activity Average patient journey time = 57 minutes Average SAS time = 1:17 (2:54) Average Escort time = 2:35 Significant impact on A&E service Adverse events reassuringly infrequent

  36. Conclusions • Projected total transported by A&E vehicles • 50,091 total IHTs per annum • 46,480 adult IHTs per annum • Total IHT activity SAS annual review • 83,000 IHTs per annum – 2007-08

  37. Recommendations Inform clinicians re use of ambulance service Use critical care trolley Establish an IHT service (incl transport paramedic) Establish transport medicine training Establish quality criteria for IHTs

  38. Acknowledgements • SICSAG - Diana Beard, Angela Kellacher • ALL STAG coordinators – especially Gaynor Howitt, Debbie Broadhurst for all those queries • Ms Judith Roulston ~ Shock Team data • Stephen Hearns, Alasdair Corfield ~ ERMS data • SAS crews ~ form completion • Clinical link personnel in individual hospitals • SGHD, IHT board ~ funding • Mr George Smith ~ database management • Mr Robert Colquhoun ~ EIS queries

  39. THANK YOU • jean.bruce@wlt.scot.nhs.uk • mike.fried@wlt.scot.nhs.uk

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