TRANSFER OF PRE-HOSPITAL CARE AND ITS POTENTIAL RISKS FOR PATIENT SAFETY

Rosane Mortari Ciconet,Jeanini Dalcol Miorin,Daiane Dal Pai,Luiza Maria Gerhardt,Maria Alice Da Silva Dias Lima,Natasha Da Silva Indruczaki

doi:10.1590/1980-265x-tce-2019-0073

Abstract

ABSTRACT Objective: to identify potential risks to patient safety during the transfer of pre-hospital care. Method: a descriptive-exploratory study, with a qualitative approach. Data collection occurred between April and June 2018, with non-participant observation and semi-structured interview, in a Mobile Emergency Care Service in the Southern Brazil. Twenty-eight professionals were interviewed, including nursing technicians/auxiliaries, nurses and physicians, and 135 hours of care were observed. The data were submitted to thematic analysis. Results: two interrelated categories emerged a) Stakeholders in patient and team safety; and b) The (inter) personal/professional dimension of the transfer of care. The study's findings showed that, in addition to the inherent vulnerabilities to traffic and urban violence, patients are exposed to circumstances that include potential risks related to falling on stretchers, medication errors and clinical judgment. The vertical communication by hierarchies, influenced by personal and emotional factors of each professional, generated implications for the continuity of care. Conclusion: given the potential risks to patient safety at the time of transfers of pre-hospital care, one should invest in effective communication strategies, as well as in forms of interpersonal relationships and links between services in the emergency network.

Highlights

Emergency mobile prehospital care is characterized by occurring in an unstable environment, with fewer possibilities for technological resources available than in hospitals, in addition to often targeting more than one victim, who often has many symptoms and/or varied clinical conditions, with a high level of severity
The findings showed that some transfers have little information since the data collection on the scene was done quickly due to the circumstances of the place, in which professionals are forced or intimidated by the population to expedite the transport of the patient to the health service of reference: After the call, the doctor said that they left quickly, we did not collect as much information, as the driver warned that it was a place where drug dealing occurs, and the population becomes aggressive, contrary to some interventions carried out or not carried out by SAMU. (O-28)
Patients are exposed to the risks inherent to the characteristics of this service, such as the performance of care while in movement during transportation, the weather and diagnostic difficulties related to the brevity and available resources of the service

Summary

Introduction

Emergency mobile prehospital care is characterized by occurring in an unstable environment, with fewer possibilities for technological resources available than in hospitals, in addition to often targeting more than one victim, who often has many symptoms and/or varied clinical conditions, with a high level of severity. It is not uncommon for the team that provides pre-hospital care to encounter little information and limited time to work. Facilitators included a non-accusatory environment, the health team’s perception that incident reports improve safety, legislated protection for those who report errors, the ability to report anonymously, education opportunities, training and clear guidelines on what must be notified.[3]

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Discussion

Conclusion