En Route Patient Safety: A Mixed-Methods Study

Abstract : Because the en route patient care environment is more complex when compared with ground-based facilities, this mixed-methods study provided a unique insight into the culture, concerns, and possible solutions associated with safe patient management during air staging and aeromedical evacuation (AE). The objectives of this mixed-methods study were to describe the perceived care culture, the gaps associated with en route patient safety, and examine solutions that might close the gaps from the perspective of the en route care providers. An explanatory sequential design was used to obtain both quantitative and qualitative data. During the first phase, quantitative data were collected via a web-based survey from a convenience sample of 236 en route personnel. This was followed by a qualitative study involving eight focus groups (n = 69) to probe and explain the survey findings in more detail. A retrospective patient record review (n = 224) provided additional information on medication discrepancies that occurred en route. Personnel and patient safety were a high priority among air staging and AE units. The most common patient safety missteps appeared to be due to a lapse in attention to detail. Reasons for these lapses seemed to stem from lack of knowledge, time, proper equipment, or physical ability/energy. These deficiencies seemed to contribute to miscommunication related to patient preparation, handoffs, and documentation of medication and/or patient status. Because en route patient care occurs in a less well-controlled environment with little immediate medical backup available, en route care providers need continued education and technical support that parallel the civilian health care system and the aviation industry to meet patient care needs during flight.