Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v7i3.5558
Abstract
The aim is to evaluate a Reason Swiss-Cheese-model-based multi-layer safety system for inter-campus transport of critically ill patients in multi-campus hospitals lacking dedicated intelligent transport dispatching platforms. This controlled study enrolled 242 patients receiving conventional transport (control group, Oct-Dec 2025) and 260 patients receiving Reason-model-guided interventions (observation group, Jan-Mar 2026). Interventions covered cross-department teamwork, a five-dimensional risk-assessment scale, emergency protocols, hierarchical training, joint drills and an RCA-driven improvement closed-loop via a lightweight QR-code-enabled online form-collection module. Baseline profiles, adverse-event rate, handover error rate, transport time expenditure, staff safety-cognition scores and patient satisfaction were compared. Groups were well-matched at baseline (P > 0.05). The observation group showed significantly lower adverse-event (3.46% vs 16.12%) and handover-omission rates (2.31% vs 14.46%), shortened transport-related durations, elevated staff safety-cognition scores (82.74 ± 3.96 vs 73.52 ± 5.17), and higher patient satisfaction (94.62% vs 78.10%) (P < 0.05 for all). This low-cost Reason-model-based safety system reduces transport risks and improves clinical outcomes. It is feasible and generalizable for grassroots multi-campus hospitals with limited IT resources.
Keywords
reason model; critically ill patients; inter-hospital transport; multihospital campus; patient safety
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[3] Lubnau, T., Lubnau II, J., & Okray, R. (2018). Gating the holes in the Swiss cheese (part I): Expanding professor Reason's model for patient safety. Journal of Patient Safety, 14(2), 101–108.
[4] Reason, J. (2012). Patient safety, human error, and Swiss cheese. Quality Management in Health Care, 21(1), 59–63.
[5] Reason, J. (1990). Human error. Cambridge University Press.
[6] Xie, J. L., Yang, X. L., Leng, Z. B., et al. (2019). Research progress on safety of inter-hospital transport for critically-ill patients. Chinese Journal of Disaster Medicine, 7(2), 115-120.
[7] Deng, L. (2024). Construction of intelligent scheduling management information system for hospital “one-stop” transport service. Chinese Journal of Hospital Administration, 40(6), 512-516.
[8] Chen, S. X. (2026). Exploration on construction difficulties and solutions of multi-campus medical information interconnection platform. Database of Chinese Sci-Tech Periodicals-Medical & Health, (3), 186-190.
[9] Van Dijk, E., Smith, A., & Lee, M. (2025). User requirements and conceptual design for an electronic data platform for interhospital transfer between acute care hospitals: User-centered design study. JMIR Human Factors, 12(1), e67884.
[10] Liu, A., Meng, Q. Q., Zhang, H. L., et al. (2021). Construction of quality evaluation indicators for intrahospital transport of emergency critically ill patients. Chinese Journal of Nursing, 56(3), 336–341.
[11] Li, S. Y., Sun, P. X., Hua, X. X., et al. (2023). Summary of best evidence for inter-hospital transport decision-making in critically ill patients. Chinese Journal of Nursing, 58(19), 2325–2331.
[12] Chen, J. Y., Shi, X. Y., Wang, Y. L., et al. (2017). Application analysis of root cause analysis based on Swiss cheese model in nursing safety management. Internal Medicine, 12(3), 420–422.
[13] Yang, Z., Zhang, B. Z., Zhang, M., et al. (2018). Application and effect evaluation of ISBAR structured communication model in handover among emergency department nurses. Chinese Health Service Management, 35(8), 579–581, 619.
[14] Petrovic, S., Vasiljevic, M., & Milenkovic, T. (2024). Intrahospital handovers before and after the implementation of ISBAR communication: A quality improvement study. Nursing Reports, 14(1), 154.
[15] Grier, S., Brant, G., Gould, T. H., et al. (2020). Critical care transfer in an English critical care network: Analysis of 1124 transfers delivered by an ad-hoc system. Journal of the Intensive Care Society, 21(1), 33–39.
[16] Cheng, J. Y., Ju, Q. Y., Liu, X. Y., et al. (2020). Application of standardized management process for inter-hospital referral of critically ill patients. Chinese Journal of Nursing, 55(12), 1791–1795.
[17] Feng, Y. P. (2020). Application of root cause analysis to reduce the incidence of adverse events in emergency nursing. Occupational Health and Emergency Rescue, 38(5), 427–430.
Copyright © 2026 Fang Wang, Jiliang Liu, Wenxue Luo, Yuman Yuan, Xia Kang
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