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Implementation of Graded Intra-Hospital Transport Protocols for ICU Patients in Southwest China: A Multicentre Cross
Na Li1, Qian Li2, Yongming Tian1
1Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background:
Intra-hospital transport of critically ill patients is a high-risk process. Although graded transport is recommended to improve safety, evidence on its implementation in southwestern China is limited.
Aim:
To describe graded intra-hospital transport implementation in ICUs in southwestern China and examine associated factors.
Study Design:
This was a multicentre cross-sectional survey conducted in ICUs across five provincial-level regions in southwestern China.
Results:
A total of 1337 ICU nurses from 201 ICUs across five provincial-level regions in southwestern China participated in this survey. Overall, 57.21% of ICUs implemented graded transport. Hospital level, teaching hospital status and higher staff-to-bed ratios were independently associated with implementation (all p < 0.001). Compared with ICUs with partial implementation, those with comprehensive implementation were more likely to allocate transport personnel by transport grade, prepare required medications, use a pre-transport checklist and plan transport routes in advance. They were also more likely to document changes in patients' condition, related interventions and signed handover records after transport (all p < 0.05). Common adverse events included decreases of >20% in heart rate, oxygen saturation, or blood pressure, insufficient oxygen supply, catheter displacement or occlusion, and fluid extravasation. Frequently perceived risk factors were patient instability, inadequate pre-transport risk assessment, incomplete transport systems and processes, and insufficient preparation of equipment and medications.
Conclusions:
Graded intra-hospital transport implementation remains inconsistent across ICUs in southwestern China and is associated with hospital characteristics and staffing resources. Comprehensive implementation may support better transport preparation, communication, documentation and adverse event reporting.
Relevance To Clinical Practice:
Safer graded transport may be promoted by strengthening structured staff training, reinforcing pre-transport risk assessment, standardising transport systems and processes, and optimising staffing and resource allocation.