CPS Safety Watch/Alert: Patient Destination Decisions

February 24, 2016    |   By: Calevir

PATIENT DESTINATION DECISIONS
Thousands of patients are treated and transported by EMS to a destination hospital every day. Most hospitals can meet the required needs of EMS patients; however, patients who have certain conditions, i.e. Stroke, STEMI, Trauma or Pediatrics, often require more specialized care as quickly as possible. These patients have time sensitive conditions called Time Critical Diagnosis (TCD).

TCD is about:

  • Early Identification
  • Appropriate Treatment
  • Appropriate Destination

Many EMS leaders, hospitals and other stakeholders have adopted the TCD concept of. This approach allows for specialized treatment when minutes matter.

However, this process does not occur on a consistent basis.Data from the Center for Patient Safety documents that some patients are not being identified and thus are not receiving the appropriate treatment and transport or that access to such specialized care is being delayed.
Transport decisions made by EMS personnel as to the appropriate hospital can make difference in a patient’s ultimate outcome.

This Safety Watch is a reminder about the important partnership EMS plays in TCD.

COMMON REPORTED CASUAL FACTORS

DIAGNOSTIC ERRORS
Some of the frequent factors include:
forgetting to perform a stroke assessment or survey
distracting injuries or complaints masking a TCD condition
not performing an ECG or unable to interpret the 12 lead ECG
and not obtaining an adequate history to learn about events leading up to the condition

UNCLEAR TRANSPORT POLICY AND HOSPITAL TCD DESIGNATION
Lack of clarity around which hospital has appropriate care available as well as decision making for transport to the appropriate location.

LACK OF RESOURCES
Long response times or remote locations in rural settings which delay access.

WEATHER CONDITIONS
Delayed transport due to poor road or flight conditions.

BLOG:

PSO Case Law: Ungurian v. Beyzman, et al., 2020 PA Super 105:

A recent Pennsylvania case shows how courts narrowly interpret the PSQIA, ignoring the D & A pathway and the clear language of the Final Rule. (Ungurian v. Beyzman, et al., 2020 PA Super 105). The cour

Joint Commission New Sentinel Event Alert 61: Managing the Risks of Direct Oral Anticoagulants:

The Center for Patient Safety wants to share this important harm-prevention advice from The Joint Commission and its Sentinel Event Alert: Managing the Risks of Direct Oral Anticoagulants. The Joint Commis

CPS Safety Watch/Alert – Culture Can Improve the Control of Multi-Drug Resistant Organisms:

Issue: A number of events reported co CPS’ Patient Safety Organization (PSO) demonstrate poor handoff communication about the patients’ infectious disease status Examples include: Patient with

Read More

RESOURCES:

The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.