Analysis of Adverse Events during Intrahospital Transportation of Critically Ill Patients

Abstract

Purpose To describe adverse events occurring during intrahospital transportation of adult patients hospitalized in an Intensive Care Unit (ICU) and to evaluate the association with morbidity and mortality. Method Prospective cohort study from July 2014 to July 2015. Data collection comprised clinical data, prognostic scores, length of stay, and outcome at hospital discharge. Data was collected on transport and adverse events. Adverse events were classified according to the World Health Organization following the degree of damage. The level of significance was set at 5%. Results A total of 293 patients were analyzed with follow-up of 143 patient transportations and records of 86 adverse events. Of these events, 44.1% were related to physiological alterations, 23.5% due to equipment failure, 19.7% due to team failure, and 12.7% due to delays. Half of the events were classified as moderate. The mean time of hospital stay of the group with adverse events was higher compared to patients without adverse events (31.4 versus 16.6 days, resp., p < 0.001). Conclusions Physiological alterations were the most frequently encountered events, followed by equipment and team failures. The degree of damage associated with adverse events was classified as moderate and associated with an increase in the length of hospital stay.

Clinical Practice Variation and Outcomes for Stanford Type A Aortic Dissection Repair Surgery in Maryland: Report from a Statewide Quality Initiative

“… 3 This finding has important ramifications for the triage of patients within our state. Although the majority of critically ill patients can be safely transported between hospitals, 11 12 it appears that well-selected patients with Stanford Type A aortic dissection can have surgical repair with comparable outcomes in smaller regional cardiac surgery hospitals, where surgeons have expertise in aortic surgery. Patients can be transported either by helicopter or ambulance to a tertiary care hospital in Maryland but sometimes weather conditions preclude a timely transfer.…”

The Transport Medicine Society Consensus Guidelines for the Transport of Suspected or Confirmed COVID-19 Patients

“… 4 – 11 These adverse events have been attributed to various factors such as a multidisciplinary team and lack of appropriate communication among team members, absence of equipment, or failure during transport, apart from physiological alteration inherent to the disease of the patient. 7 , 10 , 11 The additional concern related to COVID-19 patient's transport is the risk of viral transmission to the transport team and to other persons during the process. The safety not only of patients but also of the transport team can be ensured by the availability of working equipment, trained transport team members (including training of appropriate use of protective equipment and infection control), and written protocols.…”

“…The safety not only of patients but also of the transport team can be ensured by the availability of working equipment, trained transport team members (including training of appropriate use of protective equipment and infection control), and written protocols. 6 , 7 , 9 , 12…”

“…In spontaneously breathing patients, basic monitoring tools including electrocardiogram, noninvasive blood pressure, temperature, and pulse oximetry will be adequate. 7 For patients who are tracheal intubated, additional monitoring of capnography/end-tidal CO 2 monitoring (EtCO 2 ) is preferable. Patients should be optimally sedated (depending on the clinical condition), and if required neuromuscular blocking agents can be used during the transport to avoid coughing episodes.…”

Prevalence of Adverse Events During Transport of Critically Ill Patients From the Emergency Department to the Intensive Care Unit

“…Adverse events during the transfer of critically ill patients in the hospital are related to patient physiological changes (44.1%), transfer of equipment was 23.5% and the staff was 19.7% (Gimenez et al, 2017). Most of the adverse events related to the patient's clinical condition are the circulatory system (40%), the respiratory system (30%) and nervous system (25%) (Tolentino et al, 2018).…”