Factors that contribute to complications during intrahospital transport of the critically ill

Transporting patients from the protective environment of the intensive care (ICU) unit to other areas of the hospital has become increasingly common since high technologic testing has become an integral part of health care assessment. The hazards of moving critically ill patients by ambulance or air transport are well recognized and standards of care have been developed based on delineation of these risks. Despite the existing evidence of hazards of interhospital hospital transport, less attention has been given to the potential hazards associated with the intrahospital transport of critically ill patients. A high incidence of serious hemodynamic or respiratory alteration is associated with the intrahospital transport of critically ill patients. In one third of critically ill intrahospital transports, technical mishaps (eg, i.v. disconnects, which could potentially lead to deleterious physiologic outcomes) may occur. As patient acuity increases, there is a greater risk of hemodynamic instability. The purpose of this study was to further investigate the patient complications during transportation to and from the ICU to a diagnostic or treatment site. The sample consisted of thirty-five critically ill patients from the Neuro/Trauma ICU who required continuous physiological monitoring and had an arterial catheter in place. The systemic blood pressure, heart rate and peripheral oxygen saturation were monitored at nine time points throughout the transport process. The incidence of defined technical mishaps that occurred when the patient was off the unit were also recorded. Transport factors examined included the length of time spent off the unit and the number and level of personnel accompanying the patient. A within-subject repeat measure design was used to examine the physiologic changes and mishaps that occurred. Results indicate that while the majority of patients experienced some physiologic responses as a result of transport, the responses were not of sufficient magnitude to be classified as a deleterious. Twenty-three technical mishaps, which included inadvertent ventilator and electrocardiogram disconnects, power failures, interruption of medication administration and disconnection of drainage devices were observed. Factors related to these occurrences of technical mishaps were the number of intravenous solutions and infusion pumps and the time spent outside of the ICU environment.