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Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan
Honey M Jones1, Michael E Zychowicz, Mary Champagne
1Honey M. Jones, DNP, ACNP-BC, is an acute care nurse practitioner at Duke University Medical Center and the University of North Carolina at Chapel Hill. She also serves as clinical associate faculty for the MSN program at the Duke University School of Nursing. Her primary role is providing care for critically ill adults, and her clinical experience includes neurocritical care, cardiothoracic surgery, electrophysiology, and cardiac catheterization lab. She received her doctoral degree from Duke University, and her research interests include intrahospital transport of critically ill adults and neurocritical care practice issues. Michael E. Zychowicz, DNP, ANP, ONP, FAANP, is an associate professor and director of the MSN Program at DUSON. He is certified as both an adult nurse practitioner and an orthopedic nurse practitioner. His specialty is orthopedic nursing, with subspecialties in sports medicine, spine surgery, and general orthopedics. He received his doctoral degree from Case Western Reserve University. His research and clinical interests include occupational back injuries and the impact of health beliefs on return to work time. Mary Champagne, PhD, RN, FAAN, is Laurel Chadwick Distinguished Professor and dean emerita of DUSON. She has a secondary appointment as professor in the Department of Community and Family Medicine of the Duke University School of Medicine and is also a Senior Fellow of the Duke Center for the Study of Aging and Human Development. She received her doctoral degree from the University of Texas at Austin. Her research interests involve improving health in low-income seniors living locally in subsidized housing, quality and safety in the Duke Healthcare system, wound and ostomy care and quality of life of individuals with stomas, and the prevention of acute confusion in hospitalized elderly patients. Deirdre K. Thornlow, PhD, RN, CPHQ, is an assistant professor at DUSON, a John A. Hartford Foundation Claire M. Fagin Fellow, and a Senior Fell
Background:
Intrahospital transport of the critically ill adult carries inherent risks that can be manifested as unexpected events.
Objective:
The aim of this study is to evaluate the implementation of a standardized evaluation plan for intrahospital transports to/from adult intensive care units.
Methods:
Nurses at a level I trauma/academic center captured clinical data throughout transport. Outcome measures included compliance with the organization's transport policy and unexpected events.
Results:
There were 502 transports audited. Most nurses were compliant with the policy, except for the stabilization process (n = 174, 34.7%). Forty-one transports (8.2%) had an unexpected event, and 11 of these transports (26.8%) were aborted. Most of the events were hemodynamic (12), sedation (11), respiratory (10), and gastrointestinal (5). Fewer events occurred with the transport team (P = .036) and among nurses with a bachelor of science in nursing or higher degree (P = .002). Events were higher among transporting nurses with only 0 to 2 years of intensive care unit experience (P = .002), "stabilized" transports (P = .022), and patients with higher Acute Physiology and Chronic Health Evaluation scores (P = .009).
Conclusions:
Health care organizations should have a policy that includes both transport and evaluation plans for intrahospital transport. Guidelines should be revised with specific criteria for the stabilization process and unexpected events. Revision should also have a standardized evaluation plan that includes an audit tool to measure incidence of unexpected events and a rapid change quality improvement method.
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