Guidelines for the inter- and intrahospital transport of critically ill patients

OBJECTIVE: The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. DATA SOURCE: Expert opinion and a search of Index Medicus from January 1986 through October 2001 provided the basis for these guidelines. A task force of experts in the field of patient transport provided personal experience and expert opinion. STUDY SELECTION AND DATA EXTRACTION: Several prospective and clinical outcome studies were found. However, much of the published data comes from retrospective reviews and anecdotal reports. Experience and consensus opinion form the basis of much of these guidelines. RESULTS OF DATA SYNTHESIS: Each hospital should have a formalized plan for intra- and interhospital transport that addresses a) pretransport coordination and communication; b) transport personnel; c) transport equipment; d) monitoring during transport; and e) documentation. The transport plan should be developed by a multidisciplinary team and should be evaluated and refined regularly using a standard quality improvement process. CONCLUSION: The transport of critically ill patients carries inherent risks. These guidelines promote measures to ensure safe patient transport. Although both intra- and interhospital transport must comply with regulations, we believe that patient safety is enhanced during transport by establishing an organized, efficient process supported by appropriate equipment and personnel.     

Use of a specialized transport team for intrahospital transport of critically ill patients.

The transport of critically ill patients is challenging for nurses and patients alike. It is imperative that patient safety be the primary focus. The use of a specialized transport team can help to alleviate many of the adverse effects of the transport.     

急诊危重患者院内安全转运的护理

目的：总结急诊危重患者院内安全转运的护理。方法：对2011年10月～2012年10月应用转运制度及流程对197例危重患者的院内转运情况进行回顾性分析。结果：共发生各类不良事件82起,其中35起（42．68％）是患者本身相关的不良事件,47起（57．32％）是由于仪器设备引起的相关不良事件,经过一系列护理措施的改进,降低了患者转运途中风险的发生,确保了转运患者的安全。结论：加强护理工作者的护理安全防范意识,提高专业知识,认真执行各项制度,是确保医疗安全、提升医疗质量的关键举措。     

应用体外膜肺氧合联合机械通气的危重症新型冠状病毒肺炎患者院内转运的安全管理

本文总结了2例应用体外膜肺氧合(ECMO)联合机械通气的危重症新型冠状病毒肺炎患者院内转运的安全管理经验,包括成立ECMO转运小组、三级防护、转运前准备以及转运中和转运后的安全管理,以期为进一步提升新型冠状病毒肺炎患者院内转运效率提供参考。     

预警分级管理在急诊危重症患者院内转运中的应用效果

目的 探讨预警分级管理在减少急诊危重症患者院内转运不良事件中的应用效果。方法 我科成立项目团队,明确急诊危重症患者院内转运质量改进目标,分析患者院内转运过程中存在的问题,从病情、设备、转运人员等方面建立预警分级管理,并应用在急诊危重症患者院内转运中,比较实施前(2017年6-12月)及实施后(2018年1-6月)患者院内转运时间及转运过程中不良事件发生情况。结果 实施后,急诊科患者转运至CT室、重症病房及手术室的时间均短于实施前(t=60.557,P<0.001;t=14.096,P<0.001;t=45.117,P<0.001);实施后转运期间不良安全事件发生率显著低于实施前(χ²＝58.699,P<0.001)。结论 预警分级管理能有效缩短院内转运时间,降低急诊危重症患者院内不良安全事件发生率,提高患者院内转运安全性。     

A checklist for intrahospital transport of critically ill patients improves compliance with transportation safety guidelines

ObjectivesCritically ill patients are often transferred from the intensive care unit (ICU) to other locations around the hospital during which adverse events, some life threatening, are common. An intercollegiate guideline covering the transport of critically ill patients exists in Australasia; however, compliance with this guideline has previously been shown to be poor, and its role in improving safety in transportation of patients in the ICU is unknown. We performed a pre–post interventional study in a tertiary metropolitan ICU, assessing the impact of the introduction of a transport checklist on guideline compliance.MethodsWe performed a prospective, pre–post interventional study, including a total of 76 transfers of critically ill patients between August 2016 and April 2017.ResultsAfter introduction of the checklist, aggregate median (interquartile range) guideline compliance improved from 86.7% (80.0–92.9) to 90% (86.7–100) (p = 0.01). Significant improvements were found in notification of the transport destination (83.7% vs 100%, p = 0.010) and transporting doctors' knowledge of the Cormack–Lehane grade of laryngoscopy (60.5% vs. 84.2%, p = 0.021). There was, however, a reduction in the proportion of full oxygen cylinders taken on transports (100% vs. 76.3%, p = 0.002).ConclusionsWe conclude that a checklist is useful in improving safety in the transport of a critically ill patient population.     

ICU重症病人院内转运安全性的现状及研究进展

作者综述了ICU重症病人院内转运过程中的并发症以及决策与知情同意,详细总结了转运前的准备工作和转运过程中的病情观察及护理,并对ICU重症病人院内转运工作的发展,提出了自己的观点。     

Point-of-care blood analyzer during the interhospital transport of critically ill children.

OBJECTIVES: To investigate the influence of point-of-care laboratory results (arterial blood gases, ionized calcium, potassium, sodium, glucose, hematocrit and hemoglobin) on therapeutic interventions during interhospital pediatric intensive care transport. DESIGN: Prospective observational study. SETTINGS: Specialist pediatric intensive care retrieval team of a university hospital. PARTICIPANTS: Critically ill pediatric patients who were referred from a community hospital to a pediatric intensive care of a tertiary center. The retrieval team sampled arterial blood during the time of stabilization in the referring hospital and during transport. All results were recorded and for each result the physician of the specialist retrieval team wrote down the influence on the treatment (none, partly, only). The physician specified the kind of intervention. RESULTS: Point-of-care blood analyses influenced the therapeutic management in 76.5% of all blood samples and in 86.2% of the referred patients. Of all interventions, 42.9% were based only on the laboratory results. The majority of interventions were adjustments of the mechanical ventilation. Point-of-care blood analyses reduced the delay in treatment of potentially life-threatening abnormalities of laboratory results (severe hypokalemia and low hematocrit). CONCLUSIONS: During interhospital pediatric intensive care transport, point-of-care blood analyses frequently led to therapeutic interventions. Some abnormal blood results were potentially life threatening and could not have been discovered without point-of-care measurement. We therefore recommend the use of a point-of-care blood analyzer during interhospital intensive care transports, not only for blood gases but also for electrolytes, glucose and hematocrit.     

Intrahospital transport of critically ill patients.

Intrahospital transport of critically ill patients must be considered as part of the critical care continuum. The level of care provided must be commensurate with the severity of illness. These transfers are intensive in terms of utilization of personnel and resources. Advance preparation and optimal coordination of the transport process go a long way toward safer transfers of the critically ill.     

Active warming of critically ill trauma patients during intrahospital transfer: A prospective, randomized trial

OBJECTIVE: Hypothermia in trauma victims is a frequently observed phenomenon in acute care. Known complications of hypothermia are impaired wound healing, cardiac complications, hemodynamic instability, impaired immune function and increased blood loss. We compared active warming versus passive warming in hypothermia in critical-care patients undergoing intrahospital transfer from ICU to computer tomography (CT). METHODS: Thirty critically ill patients were randomized either to an actively warmed group, covered with a carbon-fiber heating blanket (set to 42 degrees C) during the entire transport including the time spent in the CT, or to a passively warmed group, covered with a carbon-fiber heating blanket (switched off) during the entire transport and in the CT. The carbon-fiber blanket was covered with a conventional wool blanket in both groups. Vital parameters and core temperatures were recorded. RESULTS: Patients' characteristics and vital parameters were similar in each treatment group. Initial average core temperature in group A was 36.4 degrees C +/- 0.2 degrees C and remained stable at 36.4 degrees C +/- 0.1 degrees C; core temperature in group B started at 36.4 degrees C +/- 0.2 degrees C but decreased to 34.7 degrees C +/- 0.6 degrees C. CONCLUSIONS: Hypothermia is common when critically ill trauma patients require intrahospital transport for diagnostic procedures. Resistive heating during intrahospital transport kept the core temperature stable and assured normothermia in all actively warmed patients. We therefore recommend active warming for critically ill trauma patients during intrahospital transport.     

Triage and transport of the critically ill child.

The aim of critical care transport services is the provision of care prior to and during transportation, similar to that offered in the tertiary care intensive care unit. This can only be achieved by a well prepared and equipped team dedicated to provision of this care. Appreciation of the disease conditions and adverse physiologic events likely to be encountered is necessary for the success of the team. Patient demographics and diseases in various geographic areas have been reported in the past few years. But, at the present time, team composition, responsibilities, and training requirements have not been well defined. In addition, there are no validated scoring systems to assist in team composition, triage of patients, or in the meaningful evaluation of mortality statistics. Within the next few years, one can expect to see genuine attempts made to address some of these issues.     

Cardiovascular changes during transport of critically ill and postoperative patients

We examined cardiovascular changes in 37 patients transported to an ICU after major general or vascular surgery (n = 14), open heart surgery (n = 13), or carotid endarterectomy (n = 10). Cardiovascular variables were also measured in a control group of 11 patients transported from an ICU for diagnostic or therapeutic procedures. All patients were followed for 30 min before transport until approximately 30 min after they arrived at their destinations. During this period, systolic BP and heart rate significantly increased only in patients recovering from major general/vascular surgery or carotid endarterectomy. These changes were apparently related to acute emergence from inhalational anesthesia (isoflurane plus nitrous oxide), since the other surgical patients were anesthetized with narcotic anesthesia, and the control group did not receive any anesthesia.     

Common complications in critically ill patients

Patients in intensive care units (ICUs) are subject to many complications connected with the advanced therapy required for their serious illnesses. Complications of ventilatory support include problems associated with short-term and long-term intubation, barotrauma, gastrointestinal tract bleeding, and weaning errors. Cardiac tachyarrhythmias can arise from a patient's intrinsic cardiac disease, as well as from drug therapy itself. Hemodynamic monitoring is crucial to careful patient management, but it is associated with technical complications during insertion such as pneumothorax, as well as interpretive errors such as those caused by positive end-inspiratory pressure. Acute renal failure can develop as a result both of therapy with drugs such as aminoglycosides and hypotension of many etiologies, as well as the use of contrast media. Nosocomial infection, which is a dreaded complication in ICU patients, usually arises from sources in the urinary tract, bloodstream, or lung. Complications frequently can arise if the interactions of drugs commonly used in the ICU are not recognized. Further, the ICU patient is subject to nutritional complications, acid base problems, and psychological disturbances. This monograph deals with the frequency, etiology, and prevention of these common ICU complications.