Patient Transfer Delays
More than three hours ago our plane pushed away from the gate. I am experiencing a dreaded “ground hold” with about 100 other passengers on a regional jet. Because of weather-related congestion in the northeast we can’t takeoff, and going back to the gate puts us at risk for missing a narrow takeoff opportunity. This experience reminds me of the challenges sometimes associated with transferring care of a patient at a busy emergency room.
If I was the captain of this flight (or the caregiver of a patient that needed a room, nurse and a doctor), I would:
1. Provide regular updates to the passengers or patient. Even if the update is there is no new news, a regular update is appreciated. It also is a chance to express empathy and explain how the situation is being managed.
2. Pay special attention to passengers or patients who are really young and the old. Our patients under eight and over sixty five might be at greater risk due to prolonged sitting; missing meals, medications, and regular rest schedules; and dehydration. Check on them often. With an EMS patient you have the added benefit of knowing their medical history.
3. Provide comfort measure to reduce pain and anxiety. Pillows, blankets, proper lighting, protection from temperature extremes, shielding from visual and auditory distractions, and more can help passengers or patients pass the time comfortably. If done well some patients will even drift off to sleep. The guy next to me has been snoring loudly for several hours.
4. Enable distractions. Offering free Wi-Fi would make this ground hold go faster and prolong my smartphone battery’s life. While waiting for a room with your patient, ask them or their family more about their life and experiences. If the patient is a sports fan you could offer to check the scoreboard on your smartphone.
5. Keep monitoring critical systems and equipment. As you wait, monitor and document the patient’s vital signs as often as you would during the transport phase. Make sure you have enough portable oxygen and cardiac monitor battery. Resupply from the ambulance well before you are empty.
Finally, check your emotions. Anger is not going to make the plane takeoff or the nurse take your report any sooner. Instead explain to your patient what is happening, why it is happening, and your capability, if any, to enhance the situation.
How do you manage long delays associated with transferring patient care?
Greg Friese, MS, NREMT-P, is the director of education for CentreLearn Solutions, LLC. He specializes in the development, production and distribution of online education for emergency responders. Greg is a leading advocate for the use of social media by EMS agencies and training organizations. Greg is a regular conference presenter, the co-host of the EMSEduCast, the founder of the EverydayEMSTips.com blog, marathon runner, and participant in many online EMS communities.