การพัฒนารูปแบบการส่งต่อผู้ป่วยฉุกเฉินที่มีภาวะวิกฤต โรงพยาบาลนาตาล จังหวัดอุบลราชธานี Development of Model Transfer Capability for Critically Ill Patients at Natan Hospital, Natan District, Ubonratchathani Province

Abstract

The objective of action research was to develop and evaluate the development of Mobile ICU transfer capability model for transferring critically ill patients at Natan Hospital. This study was conducted from February - December 2017 applying Stetler Model. Data were collected from 30 persons drawn from a pool of nurses and emergency medical technicians using purposive sampling. Performance of transfers were evaluated with a tool consisting of 1) knowledge and practice skills for patient care assessment, 2) quality criteria for transferring of patients derived from criteria established by the hospital accreditation team, 3) transfer satisfaction form for doctors, nurses, EMTs, ambulance drivers, and patients involved in the transfer, 4) Feasibility and appropriateness evaluation form.  A panel of five specialists verified this instrument.  Content analysis and descriptive statistics were used for quantitative and qualitative data, respectively. In addition, inferential statistics were used to evaluate the difference of mean knowledge and skill of the study participants between before and after implementation through paired t-test.

                    Through completion of the two-cycle action research process, seven training and procedural enhancements were developed and implemented at this district hospital. The enhancements focused on the creation of specific Mobile ICU capability for Natan Hospital. The specific enhancements included 1) Training of nurses for the care of critically ill patients during transfer;            2) Specifications of  team members assigned to the Mobile ICU; 3) Guidelines for when the Mobile ICU should be used to transfer; 4) Providing properly equipped vehicles (including Real Time Telemedicine) sufficient to accommodate 3 simultaneous transfers 5); Creation of a “Transfer Center” with dedicated staff to coordinate transfers; 6) Creation of procedures for all three phases of transfer (preparing and supervising before submission of transfer orders, taking care of patients during hospital delivery, and managing the post-transfer process);  7) Creation of procedures to maintain the readiness of the mobile ICU equipment for immediate deployment.  During the study period, the Mobile ICU developed as a component of this research was used for 450 transfers of critically ill patients, with no fatalities reported during transfer. It was found that after implementation, proper transfer increased 6 %. Having experienced nurses who were trained the care of critically ill patients deliver care during transfer of the patients resulted in safety transfer with no incidence of deaths. Personnel and relative were satisfied with the model at a high level (=70.17, SD=2.18) Before there was a low level of satisfaction (=34.58, SD=4.21).The mean scores of knowledge and skill regarding transfers was significantly higher during the study period compared to measurements taken in 2015 and 2016 (p<.001). it is recommended that other district hospitals develop similar Mobile ICU capability. Further study is required to determine if further improvements and efficiencies can be gained through the development of disease specific guidelines for the use of mobile ICU during transfer.