Quality of Care Issues During Transport
On occasion, quality of care issues or disputes between team members occur during transport. It is generally the responsibility of the senior medical team member to direct care (with input from online medical control as needed).
All team members have a duty to the team and to the patient to raise questions or issues of concern during the transport. Respect and trust are essential for all team members to function in the high-stress environment of a neonatal-pediatric transport. Team members need to be able to remind, recommend, and disagree in a manner that is supportive and not divisive. The team approach, however, does not mean that quality improvement is ignored.In neonatal and pediatric care, it may be particularly difficult to deal with perceived errors or shortcomings that injure a child. Great care must be exercised to avoid team conflict about a care incident that places the focus on guilt or responsibility rather than quality improvement. In these cases, extreme caution must be used to avoid accusations or judgments in the medical record or other documents. Only factual medical details should appear. Verbal comments that are critical should likewise be limited entirely to the quality review process, because they otherwise may result in additional performance and legal issues. Investigation may show that a perceived error had little or nothing to do with the adverse outcome, but premature comments or emotional criticism in the record can lead to a different conclusion. Unfortunately, misperceptions may expand into controversies and litigation that persist long after they could have been avoided or resolved.
The vast majority of pediatric and neonatal transport providers come to work each day intending to do their best for patients and their families. It is essential to create a culture of safety rather than a culture of fear and blame. Careful handling of the issues in a systematic quality improvement process tends to prevent the unnecessary controversies and identify and resolve the justified concerns.