Recommendations for the intra-hospital transport of critically ill patients (original) (raw)
Related papers
Critical Care, 2015
Introduction Transport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients. Method A three-step approach was used to develop an IHT checklist. First, various databases were searched for published IHT guidelines and checklists. Secondly, prospectively collected IHT incidents in the LUMC ICU were analyzed. Thirdly, interviews were held with physicians and nurses over their experiences of IHT incidents. Following this approach a checklist was developed and discussed with experts in the field. Finally, feasibility and usability of the checklist was tested. Results Eleven existing guidelines and five checklists were found. Only one ch...
Intrahospital transport of critically ill patients
Background: This review on the current literature of the intrahospital transport of critically ill patients addresses type and incidence of adverse effects, risk factors and risk assessment, and the available information on efficiency and cost-effectiveness of transferring such patients for diagnostic or therapeutic interventions within hospital. Methods and guidelines to prevent or reduce potential hazards and complications are provided. Methods: A Medline search was performed using the terms 'critical illness', 'transport of patients', 'patient transfer', 'critical care', 'monitoring' and 'intrahospital transport', and all information concerning the intrahospital transport of patients was considered. Results: Adverse effects may occur in up to 70% of transports. They include a change in heart rate, arterial hypotension and hypertension, increased intracranial pressure, arrhythmias, cardiac arrest and a change in respiratory rate, hypocapnia and hypercapnia, and significant hypoxaemia. No transport-related deaths have been reported. In up to one-third of cases mishaps during transport were equipment related. A long-term deterioration of respiratory function was observed in 12% of cases. Patient-related risk indicators were found to be a high Therapeutic Intervention Severity Score, mechanical ventilation, ventilation with positive end-expiratory pressure and high injury severity score. Patients' age, duration of transport, destination of transport, Acute Physiology and Chronic Health Evaluation II score, personnel accompanying the patient and other factors were not found to correlate with an increased rate of complications. Transports for diagnostic procedures resulted in a change in patient management in 40–50% of cases, indicating a good risk:benefit ratio. Conclusions: To prevent adverse effects of intrahospital transports, guidelines concerning the organization of transports, the personnel, equipment and monitoring should be followed. In particular, the presence of a critical care physician during transport, proper equipment to monitor vital functions and to treat such disturbances immediately, and close control of the patient's ventilation appear to be of major importance. It appears useful to use specifically constructed carts including standard intensive care unit ventilators in a selected group of patients. To further reduce the rate of inadvertent mishaps resulting from transports, alternative diagnostic modalities or techniques and performing surgical procedures in the intensive care unit should be considered.
Adverse events during intrahospital transport of critically ill patients: incidence and risk factors
Annals of Intensive Care, 2013
Background: Transport of critically ill patients for diagnostic or therapeutic procedures is at risk of complications. Adverse events during transport are common and may have significant consequences for the patient. The objective of the study was to collect prospectively adverse events that occurred during intrahospital transports of critically ill patients and to determine their risk factors. Methods: This prospective, observational study of intrahospital transport of consecutively admitted patients with mechanical ventilation was conducted in a 38-bed intensive care unit in a university hospital from May 2009 to March 2010. Results: Of 262 transports observed (184 patients), 120 (45.8%) were associated with adverse events. Risk factors were ventilation with positive end-expiratory pressure >6 cmH 2 O, sedation before transport, and fluid loading for intrahospital transports. Within these intrahospital transports with adverse events, 68 (26% of all intrahospital transports) were associated with an adverse event affecting the patient. Identified risk factors were: positive end-expiratory pressure >6 cmH 2 O, and treatment modification before transport. In 44 cases (16.8% of all intrahospital transports), adverse event was considered serious for the patient. In our study, adverse events did not statistically increase ventilator-associated pneumonia, time spent on mechanical ventilation, or length of stay in the intensive care unit. Conclusions: This study confirms that the intrahospital transports of critically ill patients leads to a significant number of adverse events. Although in our study adverse events have not had major consequences on the patient stay, efforts should be made to decrease their incidence.
Safety Hazards During Intrahospital Transport: A Prospective Observational Study
Objective: To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. Design: A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. Setting: The study was undertaken at two ICUs in one university hospital. Patients: Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. Interventions: None. Measurements and Main Results: Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4–10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. Conclusions: Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety. (Crit Care Med 2017; 45:e1043–e1049)
Safety Hazards During Intrahospital Transport
Critical Care Medicine, 2017
Objective: To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. Design: A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. Setting: The study was undertaken at two intensive care units in one university hospital. Patients: Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. Interventions: None. Measurements and Main Results: Content analysis was performed using deductive and inductive approaches. We detected a total 365 safety hazards (median 7; IQR 4-10) during 51 intrahospital transport of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n= 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n=61), tasks (n=83), tools and technologies (n=124), environment (n=48), and organization (n=49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. Conclusions: Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
Australian Critical Care, 2020
Background: Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur. Objectives: The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients. Methods: As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n ¼ 15) and physicians (n ¼ 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches. Results: Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards. Conclusions: To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.
https://www.ijhsr.org/IJHSR\_Vol.11\_Issue.4\_April2021/IJHSR-Abstract.018.html, 2021
The transportation of critically ill patients into or outside the hospital (ICU) has been associated with several adverse events [1, 2]. Mostly, patients admitted to the Intensive Care Unit (ICU) are considered to be critically ill. ICU can provide the best possible care to the patients, including monitoring, multiple organ support, frequent clinical round, and dedicated staff members for each patient. However, specific situations occur when the patient has to be transported out of the ICU to the best of the patient's interest. The benefits attached to the purpose of the transportation outweigh the risks. This literature review aims to summarize timely interventions, minimum standards for transportation, transport protocols, and recommendations to reduce critically ill patients to the potential risk in the ICU. We aim to improve the quality of patient care, risk evaluation, minimizing preventable hazards, standardization of the protocols, homogeneity of the modalities involved in the patient's transport, and ultimately improving the patient's health care environment. Findings show that, a total of 1.7% of adverse events during transportation was identified. In this study, 3383 charts of completed transports were observed [6]. The incidence of adverse effects is quite variable, i.e., from 1.7% to 75.7%, and in other studies, it is sometimes recorded as high as 80% [4] .