Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention

Abstract

Intrahospital transportation of critically ill patients is associated with significant complications. In order to reduce overall risk to the patient, such transports should well organized, efficient, and accompanied by the proper monitoring, equipment, and personnel. Protocols and guidelines for patient transfers should be utilized universally across all healthcare facilities. Care delivered during transport and at the site of diagnostic testing or procedure should be equivalent to the level of care provided in the originating environment. Here we review the most common problems encountered during transport in the hospital setting, including various associated adverse outcomes. Our objective is to make medical practitioners, nurses, and ancillary health care personnel more aware of the potential for various complications that may occur during patient movement from the intensive care unit to other locations within a healthcare facility, focusing on risk reduction and preventive strategies.

Keywords: Complications; critically ill patient population; intrahospital patient transfers; never events; patient safety.

Figure 1

Schematic representation of key factors associated with patient harm during intrahospital transfers. A number of patient factors (e.g., acuity of illness/severity of injury); system factors (e.g., environment change, lack of safety procedures, inadequate facilities, equipment deficiencies or failures); and personnel factors (e.g., poor communication, inadequate training, insufficient staffing, lack of supervision). The above factors frequently interact in a synergistic fashion to result in potential or actual patient harm

Figure 2

Factors contributing to complications during intrahospital transports. Fishbone diagram with patient, staff, and systems factors contributing to complications from intrahospital transport. Coronary artery disease (CAD), injury severity score (ISS), diabetes mellitus (DM)

Figure 3

Complexities of Transferring Intensive Care Unit Patients. Representative setup and important suggested equipment prior to patient arrival in a modern intensive care bed (a) Demonstrative considerations necessary for transport teams of patients with various medical equipment/apparatus (with suggested appropriate action in brackets) in order to minimize unintended harm (b-f) Intracranial pressure (ICP), Continuous renal replacement therapy (CRRT), Intravenous (IV), Left ventricular assist device (LVAD)