Patient care during interfacility transport: a narrative review of managing diverse disease states

Abstract

BACKGROUND: When critically ill patients require specialized treatment that exceeds the capability of the index hospitals, patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care. Therefore, appropriate and effi cient care for patients during the process of transport between two hospitals (interfacility transfer) is an essential part of patient care. While medical adverse events may occur during the interfacility transfer process, there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport. METHODS:We conducted searches from the PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and Scopus databases up to June 2022. Two reviewers independently screened the titles and abstracts for eligibility. Studies that were not in the English language and did not involve critically ill patients were excluded. RESULTS:The search identified 75 articles, and we included 48 studies for our narrative review. Most studies were observational studies. CONCLUSION:The review provided the current evidence-based management of diverse disease states during the interfacility transfer process, such as proning positioning for respiratory failure, extracorporeal membrane oxygenation (ECMO), obstetric emergencies, and hypertensive emergencies (aortic dissection and spontaneous intracranial hemorrhage).

Quality of inter-facility transfer for Type A aortic dissection patients in a medical center in Taiwan: a retrospective observational study

“…Considering hemodynamic management during transfer, an established protocol is needed to enable staff to regulate medication (antihypertensive or inotropic agents) according to the patients' hemodynamic variation [27]. In Taiwan, nurses can adjust the dose of medication under the guidance of a set-up protocol or order, but EMTs are not allowed to do so.…”

“…(type A AD, active upper gastrointestinal bleeding, intracranial hemorrhage, acute coronary disease...etc.) Besides, we should pay more attention to transfer safety through establishing ambulance regulations by relevant department (fire department or health authority) and promoting education course about transfer safety in staff (EMT, nurse and physician) might participate in the transfer [16,20,27].…”

“…In critical transfers such as Type A AD, STEMI, epidural hemorrhage, or major trauma, official emergency medical services (EMS) should be integrated into the inter-facility transfer to ensure that the response time interval is sufficiently short [31]. Moreover, established protocols are needed to guide each inter-facility transfer, whether official or private EMS, including staff composition, whether ALS could be provided, and advanced directives by medical directors [12,27]. Furthermore, improvement in the quality of inter-facility transfers can only be achieved by following established transfer protocols.…”