Multiprofessional team interventions in transporting critically ill patients: a systematic mixed-methods review
Intervenciones del equipo multidisciplinario en el transporte de pacientes en estado crítico: revisión sistemática de métodos mixtos
Intervenções da equipe multiprofissional no transporte de pacientes em estado crítico: revisão sistemática de métodos mistos
Ana Raquel Carreira Matias; Florinda Laura Ferreira Rodrigues Galinha de Sá
Abstract
Aim: To analyze how interventions of a multidisciplinary team promote the safe transportation of critically ill patients.
Method: A systematic mixed-methods review was developed using an integrated convergent approach according to the Joanna Briggs Institute. This study was conducted using MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials electronic databases, which generated 107 references. After removing duplicates and applying inclusion and exclusion criteria, 17 articles were evaluated for methodological quality, resulting in 15 articles as the final sample. Data extraction was performed using a tool in the form of a table and synthesized through thematic analysis.
Results: Thoughtful decision, planning, problem-solving action and action for improvement are interventions that the multiprofessional team promotes the safe transportation of critically ill patients.
Conclusion and implications for practice: The standardization of transport (institutional protocols, a checklist, and equipment adequacy), continuing education, and skills training in the capacitation of teams foster a culture of safety that prevents harm to the patient. Further research is suggested on the subjective dimension and with the family in transportation.
Keywords
Resumen
Palabras clave
Resumo
Objetivo: Analisar como intervenções da equipe multiprofissional promovem a segurança no transporte de pacientes em estado crítico.
Método: Revisão sistemática de métodos mistos elaborada com as recomendações do Joanna Briggs Institute, seguindo uma abordagem integrada convergente. A pesquisa foi realizada nas bases de dados MEDLINE, CINAHL, Cochrane Database of Systematic Reviews e Cochrane Central Register of Controlled Trials, resultando em 107 estudos. Após a remoção de estudos duplicados e a aplicação de critérios de inclusão e exclusão, 17 estudos foram avaliados quanto à sua qualidade metodológica, havendo 15 estudos na amostra final. A extração dos dados foi realizada por um instrumento em forma de tabela e sintetizada por meio de análise temática.
Resultados: A decisão ponderada, o planejamento, a atuação na resolução de problemas e a ação para a melhoria são intervenções que a equipe multiprofissional promove na segurança do transporte de pacientes em estado crítico.
Conclusão e implicações para a prática: A padronização do transporte (criação de protocolos institucionais, check-list e adequação de equipamentos), a educação permanente e o treinamento de competências na capacitação das equipes fomentam uma cultura de segurança que evita o dano ao paciente. Sugerem-se pesquisas sobre a dimensão subjetiva e a inclusão da família no transporte.
Palavras-chave
Referências
1 Corrigan JM, Kohn LT, Donaldson MS, Maguire SK, Pike KC. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.
2 WHO: World Health Organization. World Alliance for Patient Safety: forward programme. Genebra: WHO; 2005.
3 WHO: World Health Organization. Global patient safety action plan 2021-2030: Towards eliminating avoidable harm in health care. Geneva: WHO; 2021.
4 WHO: World Health Organization. World Alliance for Patient Safety, Taxonomy: The Conceptual Framework for the International Classification for Patient Safety: final technical report. Geneva: WHO; 2009.
5 Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: The National Academies; 2000.
6 Santos BS, Bueno CKS, Bizinelli TSQ, Ribeiro, ER. A segurança no transporte do paciente crítico em ambiente intra-hospitalar: uma revisão integrativa. Rev Espaço para a Saúde. 2019;20(2):90-101.
7 Portaria MS/GM nº 529, de 1 de abril de 2013 (BR). Institui o Programa Nacional de Segurança do Paciente (PNSP). Diário Oficial da União [periódico na internet], Brasília (DF), 2013 [citado 15 nov 2021]. Disponível em.
8 Despacho n.º 9390/2021, de 24 de setembro (PT). Sumário: Aprova o Plano Nacional para a Segurança dos Doentes 2021 -2026 (PNSD 2021 -2026). Diário da República [periódico na internet], Portugal, 2021 [citado 15 nov 2021]. Disponível em:
9 Benner P. De Iniciado a Perito: Excelência e Poder na Prática Clínica de Enfermagem. Tradução de Ana Albuquerque Queirós e Belarmina Lourenço. Coimbra: Quarteto Editora; 2001.
10 Benner P, Kyriakidis PH, Stannard D. Clinical wisdom and interventions in acute and critical care: A thinking-in-action approach. 2nd ed. New York: Springer Publishing Company; 2011.
11 Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: recent concepts. Indian J Anaesth. 2016;60(7):451-7.
12 Droogh JM, Smit M, Absalom AR, Ligtenberg JJM, Zijlstra JG. Transferring the critically ill patient: are we there yet? Crit Care. 2015;19(1):62.
13 Sharafi RA, Ghahramanian A, Sheikhalipour Z, Ghafourifard M, Ghasempour M. Improving the safety and quality of the intra-hospital transport of critically ill patients. Nurs Crit Care. 2021;26(4):244-52.
14 Bourn S, Wijesingha S, Nordmann G. Transfer of the critically ill adult patient. BJA Educ. 2018;18(3):63-8.
15 Ordem dos Médicos, Sociedade Portuguesa de Cuidados Intensivos. Transporte de Doentes Críticos – Recomendações 2008. Lisboa: Comissão da Competência em Emergência Médica. 2008.
16 Intensive Care Society. Guidance on: the transfer of the critically ill adult. United Kingdom: Faculty of Intensive Care Medicine; 2019.
17 Lizarondo L, Stern C, Carrier J, Godfrey C, Rieger K, Salmond S et al. Chapter 8: mixed methods systematic reviews. In: Aromataris E, Munn Z, editores. JBI manual for evidence synthesis [Internet]. Austrália: JBI; 2020 [citado 15 nov 2021]. Disponível em:
18 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71.
19 Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M et al. Mixed Methods appraisal tool (MAAT) – User guide. Canadá: McGill University; 2018.
20 Galvão MCB, Pluye P, Ricarte ILM. Métodos de pesquisa mistos e revisões de literatura mistas: conceitos, construção e critérios de avaliação. InCID: R Ci Inf e Doc. 2017;8(2):4-24.
21 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.
22 Allen R, Wanersdorfer K, Zebley J, Shapiro G, Coullahan T, Sarani B. Sarani. Interhospital transfer of critically ill patients because of coronavirus disease 19−related respiratory failure. Air Med J. 2020;39(6):498-501.
23 Bergman L, Pettersson M, Chaboyer W, Carlstrom E, Ringdal M. Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study. Aust Crit Care. 2020;33(1):12-9.
24 Bérubé M, Bernard F, Marion H, Parent J, Thibault M, Williamson D et al. Impact of a preventive programme on the occurrence of incidents during the transport of critically ill patients. Intensive Crit Care Nurs. 2013;29(1):9-19.
25 Burrell AJC, Pilcher DV, Pellegrino VA, Bernard SA. Retrieval of adult patients on extracorporeal membrane oxygenation by an intensive care physician model. Artif Organs. 2018;42(3):254-62.
26 Comeau OY, Armendariz-Batiste J, Woodby SA. Safety first! Using a checklist for intrafacility transport of adult intensive care patients. Crit Care Nurse. 2015;35(5):16-25.
27 Doucet CL, Rhéaume A. Impact of an inter-hospital transfer online module on critical care nurses’ preparedness for transfers. Can J Crit Care Nurs [Internet]. 2020; [citado 2021 nov 15];31(2):29-36. Disponível em:
28 Eiding H, Kongsgaard UE, Braarud AC. Interhospital transport of critically ill patients: experiences and challenges, a qualitative study. Scand J Trauma Resusc Emerg Med. 2019;27(1):27.
29 Gillman L, Jacobs I, Fatovich DM. Challenges in arranging interhospital transfer from a non-tertiary hospital emergency department in the Perth metropolitan área. Emerg Med Australas. 2014;26(6):567-72.
30 Gimenez FMP, de Camargo WHB, Gomes ACB, Nihei TS, Andrade MWM, Valverde MLAFS et al. Analysis of adverse events during intrahospital transportation of critically ill patients. Crit Care Res Pract. 2017;2017:6847124.
31 Habibzadeh F, Aliha JM, Imanipour M, Mehran A. The effect of interactive workshop on the quality of intra-hospital patients’ transfer: a quasi-experimental study. Nursing Practice Today [Internet]. 2017; [citado 15 nov 2021];4(2):79-86. Disponível em:
32 Hui YY, Lo WYL, Lee LLY, Chan JTS, Tang SYH, Kalinowski E. Measuring performance of night-time interfacility transport service. Eur J Emerg Med. 2012;19(4):264-6.
33 Jones HM, Zychowicz ME, Champagne M, Thornlow DK. Intrahospital transport of the critically ill adult: a standardized evaluation plan. Dimens Crit Care Nurs. 2016;35(3):133-46.
34 Kwack WG, Yun M, Lee DS, Min H, Choi YY, Lim SY et al. Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team: a cohort study. Medicine (Baltimore). 2018;97(48):e13490.
35 Maddry JK, Arana AA, Savell SC, Reeves LK, Perez CA, Mora AG et al. Critical care air transport team evacuation of medical patients without traumatic injury. Mil Med. 2017;182(11):e1874-80.
36 Petry L, Diniz MBC. Communication between teams and the care transfer of critical patients. Rev Rene. 2020 mar 18;21:e43080.
37 Chang YC, Chou LT, Lin HL, Huang SF, Shih MC, Wu MC et al. An interprofessional training program for intrahospital transport of critically ill patients: model build-up and assessment. J Interprof Care. 2019;23:1-5.
38 Williams P, Karuppiah S, Greentree K, Darvall J. A checklist for intrahospital transport of critically ill patients improves compliance with transportation safety guidelines. Aust Crit Care. 2020;33(1):20-4.
39 Mendes AP. Uncertainty in critical illness and the unexpected: important mediators in the process of nurse-family communication. Esc Anna Nery. 2020;24(1):e20190056.
Submetido em:
10/12/2021
Aceito em:
09/05/2022
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email