From the 2022 HVPA National Conference
Gabrielle Matias MD (Loyola University Medical Center), Brian White MD, Devin Williams MD
Background
Intra-hospital transport of critically ill patients is often associated with adverse events (AE). This study analyzed the prevalence of intra-hospital transport AE from the medical ICU (MICU). Based on these results, a “Transport Tool” (“TT”) was developed and will be used to determine if such a tool can reduce transport-related AE.
Objective
1. Develop a “TT” that includes risk stratification based on risk factors identified from the baseline periods along with a safety checklist
2. Determine whether implementing the “TT” in the MICU reduces transport-related AE
Methods
This study consists of two sequential branches. First, through a prospective cohort study, all patients that underwent an intra-hospital transport from the MICU with a completed transport survey were included. Nurses recorded length and reason of transport, who was present during transport, and any AE. Clinical information for these patients, before and after transport, were then reviewed. Second, based on the initial survey results, a “TT” was developed with a weighted risk stratification scoring system for transport. This sorts potential transport patients into “Low”, “Moderate” and “High” risk categories. “High” and “Moderate” risk patients are then reviewed according to a Safety Checklist with “High” risk patients also reviewed by the senior resident.
Results
The baseline survey period included 52 transport events; 16/52 (30.8%) encountered AE. These identified 6 risk factors (nurses noting they have inadequate support during transport, hypotension [SBP <90], overnight transport, patients on sedative/analgesic/vasoactive drip, ventilated patients, total transport time expected to take >45 minutes). The intervention survey period with implementation of the “TT” included 37 transport events; 5/37 (13.5%) encountered AE. This is a 56.2% reduction of AE after implementing the “TT” (χ2 value: 3.57; p-value 0.059). 22/37 triggered a checklist review with 11 undergoing further MD review.
Conclusion
We describe a novel patient transport safety checklist that demonstrates a remarkable reduction in adverse event after its implementation. Clinically, this reduces unwanted outcomes during diagnostic or therapeutic transport for critically ill patients.
