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987 / Transportation system for patients with cardio-pulmonary resuscitation

GERMANY
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Care for patients with Acute Myocardial Infarction (AMI)
Handover situations / Transfer of patients There is no specified text here
Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
Initial situation:
The in-hospital transport for patients who arrive at our clinic via rescue services is solved in an unsatisfactory way with "running“ Cardiopulmonary resuscitation (CPR) – artificial respiration and heart massage. According to the current guidelines of the international medical societies, the performance of a sufficient CPR should not be interrupted during transport. However, sufficient chest compressions are not possible because of the height of the stretcher systems which are used in German ambulances (approx. height 105 cm). For an average sized Emergency Medical Technician (EMT), it is almost impossible to carry out sufficient CPR (Document, Images 4 and 5). On the way from the ambulance to the Intensive Care Unit (ICU) CPR cannot be sufficiently or not at all performed. Therefore, there is a danger of damaging vital organs (brain, heart) during the transport. There is clearly a need to improve the process of the quality of patients' transport during the CPR on the way from the ambulances to ICU.

Problem-solving approach:
To perform sufficient chest compressions, it is necessary to put the Emergency Medical Services (EMS) stretcher on a special transport trolley at the entrance of the emergency department. This special transport trolley is ca. 65 - 70 cm lower than the EMS chassis (height approx. 105 cm). In addition, the transport trolley is equipped with a standing-platform (also called "dinghy"). On this standing-platform the nurse or EMT can ride along and perform CPR during the transport of the patient. This system was invented by the nursing team of the ICU.
Description of the Patient Safety Practice
 
Description of the transporting system:
Both the lower transport trolley and the standing-platform were built on the basis of the Straubing idea by the company Hell, Diespeck. All stretchers used in the Straubing area (Red Cross, Maltesian, ADAC-air rescue) can be safely stored on the trolley (without the chassis). Retractable metal lattices allow the fixation of the EMS stretcher and can be used to run and stop the trolley. A large storage area under the stretcher allows the rapid use of monitoring devices and ventilators during transportation. In addition the car is equipped with standard rails to fix medical equipment. (Document, Image 1).

Description of the transport process:
The special transport trolley is located in the entrance hall of the emergency department.
The admission of a patient under special circumstances like CPR is announced by the EMS radio control center. Nurses from the emergency department or ICU go to the entrance hall and support the EMS team during the transport process. In order to transport emergency patients under sufficient CPR the patients are lifted on the lower special transport trolley with the EMS stretcher. A medical person performs CPR while standing on the platform during transport from the emergency department to the ICU (Document, Images 2 and 3). Ventilators, monitoring devices, etc. can be placed on the board below the stretcher.

Extension of the process:
The special transport trolley is also used for the transport of trauma patients under CPR from the shock room for example to the operating room.

Safety instructions:
The transport trolley and the connected processes were presented to the safety officer of the hospital. No objections emerged.
During a “ride” of a staff member on the standing-platform all participating persons have to take special care of this person, since there are no special protection and fixation facilities for this person.
All team members involved in transportation from emergency room to ICU must be trained in the use of the CPR transport trolley "Straubing".

For more information (also in German) and the pictures, please see:
987-Dr._Mrugalla_Additional information_AQuMed.zip
Attachment of relevant written information and/or photos, as appropriate
PSP_987_Mrugalla.pdf
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There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Not known
A baseline measurement before implementation of the reported practice was obtained
Not known
A measurement after full implementation of the reported practice was obtained
Not known
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
There is no specified text here
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Primary care
Hospital
Transport services (incl. ambulances)
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Health care assistants
Therapists
Technical support / technician
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Not known or not relevant
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Not relevant
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Rolf Mrugalla
Country: GERMANY
Organisation: Klinik für Anästhesie und Operative Intensivmedizin Klinikum St. Elisabeth Straubing
E-mail: rolf.mrugalla@klinikum-straubing.de
Phone: 004994217106804
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