การวิเคราะห์สถานการณ์การบริหารความเสี่ยงในการส่งต่อผู้ป่วยระหว่างโรงพยาบาล โรงพยาบาลบ้านโคก จังหวัดอุตรดิตถ์

Abstract

Risk management during patients’ inter-hospital transfer aims to reduce and correct potential risks that could lead to patient injury. The objectives of this descriptive study were to describe the situation of risk management during patients’ inter-hospital transfer of Bankhok Hospital, Uttaradit province and to propose ways to solve risk management problems. The participants included 12 hospital personnel. Data were collected using semi-structure interviews, a focus group discussions and documentation reviews. Content analysis was applied for data analysis based on the quality assessment framework by Donabedian (2003) which consists of 3 aspects: 1) structural aspect, 2) process aspect, and 3) outcome aspect. The results were as follows: 1. Structural aspect: Bankhok hospital has managed risks during patients’ inter-hospital transfer by using risk management policies which emphasize the safety of both health care providers and clients. The hospital administrator assigned hospital personnel to perform duties regarding patient transfer and the budget has been allocated to purchase essential medical equipment and supplies. However, due to limited budget, there was insufficient medication and advance life support equipment. Shortage of hospital personnel, inexperienced nurses and a heavy workload were also found to be problems. Suggestions included providing sufficient medication, sufficient medical equipment and supplies, adequate staffing and also supporting nursing personnel to enhance knowledge and skills. 2. Process aspect: There were four steps for risk management during patients’ inter-hospital transfer of Bankhok hospital consisting of risk identification, risk assessment, action to manage risk, and evaluation. Identified problems consist of: lack of awareness of incident reporting, incorrect assessment of risk severity, inadequate knowledge regarding use of tools for quality improvement and not following patient safety guidelines. Recommendations were made as follows: 1) raising awareness of hospital personnel on reporting incidents, 2) educating hospital personnel regarding risk severity and use of tools for quality improvement, and 3) encouraging hospital personnel to follow patient safety guidelines. 3. Outcome aspect: It was found that undesirable events during the patients’ inter-hospital transfer of this hospital were increasing during the past few years. The result of this study could be used as baseline information regarding risk management during patients’ inter-hospital transfer of Bankhok hospital, Uttaradit province. It is recommended that hospital administrators and nurse administrators use this information to develop strategies to improve risk management during inter-hospital transfer.