Recommendations for the intra-hospital transport of critically ill patients

Abstract

Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intra-hospital transport (IHT).

Methods: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied.

Results: This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A check-list for quick execution of IHT is then put forward and justified.

Conclusions: Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit analysis are currently the only deciding factors. A critically ill patient, prepared and accompanied by an inexperienced team, is a risky combination. The development of adapted equipment and the widespread use of check-lists and proper training programmes would increase the safety of IHT and reduce the risks in the long-term. Further investigation is required in order to evaluate the protective role of such preventive measures.

Figure 1

Main serious adverse events identified since 2004 in studies by Lahner [14], Papson [16], Beckmann [7], Damm [9]and Gillman [12].

Figure 2

A comprehensive illustration of the several circumstances leading to a minor and then to serious AE during IHT. Dashed green lines: Regular checks and corrective action guided by a check-list before, during and after IHT. AE, adverse event; ICU, intensive care unit; IHT, intra-hospital transport.