Inter-hospital and intra-hospital patient transfer: Recent concepts (original) (raw)
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Air medical transportation in India: Our experience
Journal of Anaesthesiology Clinical Pharmacology, 2016
Background and Aims: Long distance air travel for medical needs is on the increase worldwide. The condition of some patients necessitates specially modified aircraft, and monitoring and interventions during transport by trained medical personnel. This article presents our experience in domestic and international interhospital air medical transportation from January 2010 to January 2014. Material and Methods: Hospital records of all air medical transportation undertaken to the institute during the period were analyzed for demographics, primary etiology, and events during transport. Results: 586 patients, 453 (77.3%) males and 133 (22.6%) females of ages 46.7 ± 12.6 years and 53.4 ± 9.7 years were transported by us to the institute. It took 3030 flying hours with an average of 474 ± 72 min for each mission. The most common indication for transport was cardiovascular diseases in 210 (35.8%) and central nervous system disease in 120 (20.4%) cases. The overall complication rate was 5.3% There was no transport related mortality. Conclusion: Cardiac and central nervous system ailments are the most common indication for air medical transportation. These patients may need attention and interventions as any critical patient in the hospital but in a difficult environment lacking space and help. Air medical transport carries no more risk than ground transportation.
When place and time matter: How to conduct safe inter-hospital transfer of patients
Saudi Journal of Anaesthesia, 2014
or issues of funding of medical treatment. Thus, IHT of patients is now an integral process and essential component of health-care system. Optimal health and well-being of the patient is the underlying goal of IHT. Therefore, the decision to transfer is patient-centered and is undertaken when the benefi ts of transfer outweigh the risks. [10] Choice of the destination hospital should be based primarily on infrastructure, availability of specialized care and proximity to the referring hospital, the aim being to seek transfer to a hospital nearby providing the highest quality care. [11] Once the decision is made, the transfer process must be initiated and completed as soon as possible. [12] Both the referring and receiving hospitals should thereafter focus on the continuity of medical care and not just on administrative procedures of discharge and re-admission. IHT carries its own risk and a poorly and hastily conducted transfer increases morbidity and mortality risk for patients. [13-15] Therefore, a well-organized system with appropriate equipment and personnel is crucial for a safe IHT.
2018
Introduction: Most of the patients hospitalized in the emergency department (ED) are in need of transfer to other hospital wards or paraclinic units. This process is called intrahospital transfer (IHT) that may lead to a wide range of complications known as unexpected events (UE). Objective: In the present study we decided to evaluate the effect of using a pre-designed protocol on decrease of UEs and safety improvement of IHT among patients hospitalized in ED. Method: The present cross-sectional study was carried out in 2016 in the ED of Imam Khomeini Hospital, Tehran, Iran. All patients with triage levels of 1 and 2 who were in need of temporary or permanent transfer to other departments of the studied treatment center based on clinical indication as decided by the in-charge physician were enrolled in the study. This study was conducted in 3 phases of pre-intervention, intervention and post-intervention. Any UE was recorded in first phase. During intervention phase ED-IHT protocol was prepared and implemented. the checklist of complications and UEs during transfer was filled again and pre-and post-intervention results were compared. Results: In this study, 207 patients with the mean age of 58.9 ± 20.6 years were evaluated (61.4% male). Demographic data and baseline characteristics of the studied patients in the phases before and after implementation of the protocol has no significant difference. Overall, before implementation of the protocol out of the 105 studied patients, a total of 35 patients (33.3%) were affected by UE during transfer, but after implementation of the protocol this rate decreased to 11 patients (10.8%) out of the 103 studied patients and this decrease was statistically significant (p < 0.001). Conclusion: Based on the results obtained from this study, it seems that performing the IHT protocol specialized for ED patients has been effective in decreasing UE cases.
RECORDS OF INTER-HOSPITAL TRANSFER OF PERSON IN CRITICAL SITUATION (Atena Editora)
RECORDS OF INTER-HOSPITAL TRANSFER OF PERSON IN CRITICAL SITUATION (Atena Editora), 2023
Inter-hospital transfers (ITH) are procedures that require prior preparation by nurses to ensure safety during the process. In order to prevent the risk associated with transfers, institutions must implement a specific transfer plan, with an efficient system of material, human and documentation resources. Nursing records (RE) must reflect the nurse's critical thinking, describe the problems that the user presents, the nursing interventions carried out and the results achieved sensitive to nursing interventions. A continuous quality improvement project was developed through action research methodology, with the objectives of analyzing nursing records relating to HIT of people in critical situations; implement strategies to improve the records analyzed and evaluate nurses' satisfaction with the interventions implemented. A “check-list” was used to verify data recorded in the clinical files of users undergoing HIT. A “standard” record, pre-structured and editable in the computer program used, was made available to nurses in a medical-surgical emergency service in Portugal. After implementing the interventions, an electronic questionnaire was administered to nurses to assess their satisfaction with the process. The content of the RE of transferred users was evaluated, and it was possible to verify the existence of omission/lack of information on the preparation of inter-hospital transfers in the RE. The reasons associated with this non-existence are associated with issues of time management and poor prioritization of care by nurses. After implementing the interventions, the nurses evaluated them as positive and reported being satisfied with them. Overcrowding in emergency services due to a large influx associated with a lack of human resources, the need to develop skills such as time management, can lead to inadequate documentation of care.
World Journal of Surgery, 2014
Objectives Outcomes of surgical emergencies are associated with promptness of the appropriate surgical intervention. However, delayed presentation of surgical patients is common in most developing countries. Delays commonly occur due to transfer of patients between facilities. The aim of the present study was to assess the effect of delays in treatment caused by inter-facility transfers of patients presenting with surgical emergencies as measured by objective and subjective parameters. Methods We prospectively collected data on all patients presenting with an acute surgical emergency at Aga Khan University Hospital (AKUH). Information regarding demographics, social class, reason and number of transfers, and distance traveled were collected. Patients were categorized into two groups, those transferred to AKUH from another facility (transferred) and direct arrivals (nontransfers). Differences between presenting physiological parameters, vital statistics, and management were tested between the two groups by the chi square and t tests. Results Ninety-nine patients were included, 49 (49.5 %) patients having been transferred from another facility. The most common reason for transfer was ''lack of satisfactory surgical care.'' There were significant differences in presenting pulse, oxygen saturation, respiratory rate, fluid for resuscitation, glasgow coma scale, and revised trauma score (all p values \0.001) between transferred and nontransferred patients. In 56 patients there was a further delay in admission, and the most common reason was bed availability, followed by financial constraints. Three patients were shifted out of the hospital due to lack of ventilator, and 14 patients left against medical advice due to financial limitations. One patient died. Conclusions Inter-facility transfer of patients with surgical emergencies is common. These patients arrive with deranged physiology which requires complex and prolonged hospital care. Patients who cannot afford treatment are most vulnerable to transfers and delays.
Indian Journal of Critical Care Medicine, 2019
Background and aims: Patients' outcome after ICU transfer reflect hospital's post-ICU care status. This study assessed association of after-hour ICU transfer on patient outcome. Subjects and methods: Single-centre, retrospective analysis of data between March2016 to April2017 at a tertiary-care hospital in India. Patient data were collected on all consecutive ICU admissions during study period. Patients were categorized according to ICU transfer time into daytime(08:00-19:59 hours) and after-hour(20:00-07:59 hours). Patients transferred to other ICUs/hospitals, died in ICU, or discharged home from ICU were excluded. Only first ICU admission was considered for outcome analysis. Primary outcome-hospital mortality; secondary outcomes-ICU re-admission and hospital length of stay (LOS). All analysis were adjusted for illness severity. Results: Of 1857 patients admitted during study period,1356 were eligible for study; 53.9% were males and 383(28%) patients transferred during after-hour. Mean age of two groups (daytime vs. after-hour 65.7±15.2 vs. 66.3±16.2 years) was similar (p = 0.7). Mean APACHE IV score was comparable between daytime vs. after-hour transfers (45.6±20.4 vs 46.8±22; p = 0.05). Unadjusted hospital mortality rate of after-hour-transfers was significantly higher compared to daytime-transfers (7.1% vs. 4.1%; p = 0.02). After adjustment with illness severity, after-hour-transfers were associated with significantly higher hospital mortality compared to daytime-transfers(aOR1.7, 95%CI 1.1,2.8; p = 0.04). Median duration of hospital LOS and ICU re-admission though higher for after-hour-transfers, was not statistically significant in adjusted analysis (aOR hospital-LOS 1.1, 95% CI 0.8, 1.4, p = 0.5; aOR readmission 1.6, 95% CI 0.9,2.7; p = 0.06 respectively). Conclusion: After-hour-transfers from ICU is associated with significantly higher hospital mortality. Hospital LOS and readmission rates are similar for daytime and after-hour-transfers.
Patient Transfer Practices By Hospitals In Western Kenya
East African Medical Journal, 2008
Background: Patients who are critically ill and those requiring emergency care are transported within and between hospitals on a regular basis seeking diagnostic or therapeutic services not available at the bed side or within the referring institution. The emergency of specialty systems often determines the ultimate destination of patients rather than proximity of facility and this has heightened the need for patient transfer. To achieve a favorable outcome, it is necessary to ensure that any transfer is carried out safely and effectively with minimum disruption of the continuum of care. Objectives: To determine the gap between existing knowledge of patient transfer principles and the practice by hospitals in Western Kenya referring patients to Moi Teaching and Referral Hospital (MTRH). Design: Cross-sectional descriptive study. Setting: Accident and emergency department at MTRH. Subjects: Patients transferred in over a period of six months for critical/emergency care. Results: Evaluation was done for 97 transfers during the six months period. Age ranged from four days old to 70 years with a median of 28 years. A wide spectrum of diseases were seen. However in order of frequency the leading five were; trauma and accidents, vascular disorders, infections; anaemia and malignancies. Of the infections, respiratory infections topped the list with pulmonary tuberculosis as the leading disease entity. Majority of patients 43 (44%) were referred within 24 hours of being seen at the primary hospital. Only 56% were transported by ambulance; appropriate escort(nurse) was provided in 60%; documentation was provided in 85%; monitoring enroute was done in 24%; warmth was provided in 62%, 27% were dehydrated requiring resuscitation; respiratory support was inadequate as only 14% (of those who required) had airway and 32% had oxygen provided; intravenous fluids were provided in 34% of those who required; nasogastric intubation was provided in 30% of those who required; urethral catheterisation was provided in 23% of those who required; 50% of those with long bone fractures were splinted and only 3% of those who required cervical spine stabilisation had cervical collar. Conclusion: There was significant failure by hospitals in Western Kenya in the application of principles of patient transfer while referring patients to MTRH.
Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital
2005
This retrospective study was undertaken to evaluate and identify some difficulties encountered in the process of interhospital transport of pediatric critically ill patients from remote hospitals to the Pediatric Intensive care unit (PICU) of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The study was conducted between 1st June, 2001 and 30th June, 2003. Total number of patients transferred to PICU were 36. Most patients suffered from respiratory diseases (14 cases, 38.9%) and cardiovascular diseases (8 cases, 22.2%) prior to transfer. Five patients (13.9%) had cardiac arrest and required CPR prior to the transfers. Twelve cases (30%) were transferred at the parents' request or and due to socioeconomic problems. All patients were transported by ambulance. The longest transfer duration was from a hospital in Chiangmai province (11 hours by road transfer). The majority of accompanying medical personnel were nurses (55.5%) with no experience in intensive care ...