What Are the Safety Issues in the Intra-Hospital Transport of Critically Ill Patients?
The Intensive Care Unit (ICU) is a centralized location for the diagnosis, treatment, and management of critically ill patients. Patients admitted to the ICU are characterized by severe conditions, rapid changes, and a high incidence of unexpected events. They often require transfer to auxiliary departments, specialized wards, or operating rooms for targeted treatment (with a transfer rate as high as 44%)¹. However, due to sudden changes in the treatment environment, a lack of therapeutic resources during transport, and the use of inappropriate transfer equipment, these patients are prone to clinical deterioration or unexpected events, posing significant safety risks.
Transport of Critically Ill Patients
Studies have found that the incidence of adverse events during intra-hospital transport of critically ill patients ranges from 46.2% to 79.8%.² In 2015, the United States listed "patient transport" as one of the top ten patient safety problems.
Based on scientific research and detailed analysis of intra-hospital transport data⁴, the occurrence of adverse events during the intra-hospital transport of critically ill patients is primarily attributed to the following six factors:
1. Changes in Patient Condition
Research indicates that the primary reasons for emergency calls during the transport of critically ill patients are cardiovascular system changes (41%), mainly new-onset arrhythmias (occurrence probability 0.7%–2.4%) and cardiac arrest. This is followed by respiratory system issues (29%), primarily hypoxia (SpO2 <90% for over 5 minutes) and airway obstruction. Additionally, there are changes in other systems, such as neurological (14%), mental status (9%), digestive system alterations, as well as hyperglycemia and hypoglycemia.³
2. Equipment Malfunction, Power Depletion, or Oxygen Insufficiency
Notably, equipment-related problems account for up to 64.5% of adverse events during intra-hospital transport of critically ill patients.³ The main aspects include:
(1) Ventilators: Malfunction, battery depletion, disconnection of tubing, accidental switch deactivation.
(2) Monitors: Malfunction, battery depletion, disconnected ECG leads, disconnection of blood pressure or SpO₂ sensors.
(3) Infusion Pumps: Functional failure, battery depletion, alarm failure.
(4) Oxygen Supply: Insufficient oxygen reserve, unopened valve, dislodged catheter or mask.
(5) Transport Beds/Stretchers: Functional failure, patient fall due to unraised side rails.
Therefore, effective pre-, during-, and post-transport checks of equipment, along with the use of high-quality transport bed/stretcher equipment, are crucial.
Pre-transport: Regularly inspect equipment functionality and battery status, complete equipment checklists, verify oxygen bags for leaks.
During transport: Secure all devices and instruments, continuously monitor machine operation, avoid accidental contact leading to shutdown.
Post-transport: Attach low-battery warning tags to equipment with depleted charge, assign clear maintenance responsibilities to specific personnel.
3. Insufficient Fluid or Medication Supply
Interruption of infusion due to insufficient fluids/medications, and delayed administration due to lack of emergency or other required drugs are also contributing factors to adverse eventsduring transport, although their incidence is relatively low (0.2%–3.9%).³
4. Secondary Injury or Worsening Condition Due to Improper Handling During Patient Transfer
Particularly for critically ill patients post-neurosurgical or orthopedic surgery, who require specific positioning during transfer, improper handling can easily cause secondary injury, thereby increasing the risk of medical disputes. In recent years, medical disputes arising from falls during transport and transfer are not uncommon, with some hospital compensations reaching millions.
5. Catheter or Tubing Issues
During transport, the incidence of catheter dislodgement, obstruction, accidental removal, and infusion line disconnection, blockage, or kinking is as high as 46%.³
Effective management of catheters and lines is therefore essential.
Pre-transport: Verify all patient lines and their secure fixation; reinforce any loose lines promptly.
During transport: Secure items on the transport vehicle to avoid pulling on lines. Apply appropriate restraints for agitated patients.
Post-transport: Re-check all lines for dislodgement and complete proper handover documentation.
6. Organizational and Management Issues
These mainly manifest in several situations: patient misidentification, lack of signed informed consent from patient/family, omission of patient belongings (medical records, personal items, medications), delayed transport, aborted transport mid-route, incorrect destination, refusal of acceptance at the destination, excessive waiting time at the destination, elevator problems, etc.
Before transport, carefully verify patient identity, inform the patient and family of the transport purpose, obtain signed informed consent, and communicate effectively with relevant departments. Establish dedicated transport pathways or utilize access control systems in advance.
During transport, the life safety of critically ill patients entirely depends on the comprehensive pre-transport assessment by accompanying medical staff, meticulous preparation, close monitoring en route, timely and effective emergency measures, and high-quality transport equipment. Only by excelling in all these aspects can the safety of critically ill patients during transport and transfer be ensured.
Among these, the Medical Electric Transfer Bed, developed over several years by Strength Medical, is designed to effectively address safety, comfort, and convenience issues for patients during transfer and transportation within medical institutions.
The product features movable safety rails and a safe load capacity of 150 kg, resolving concerns about low carrying capacity and ensuring patient safety during transfer and transport. Additionally, it is equipped with an electric power-assist system, enabling even single-operator rapid transfer of patients to nearby treatment areas. The built-in battery can power various monitoring devices and instruments, facilitating continuous vital signs monitoring during transport. A dedicated oxygen cylinder bracket provides respiratory support for critically ill patients requiring it. Furthermore, the integrated retractable stretcher board enables seamless patient transfer, effectively enhancing the safety and comfort of critically ill patients during transport, ushering in a new era of safe and intelligent patient transfer in hospitals!
References:
1. Voigt LP, Pastores SM, RaoofND, Thaler HT, Halper NA. Rewew of a large cinical senies: intrahospitaltransport of cnticallyillpatients: outcomes, timing, andpatems JIntensive Care Med 2009 Mar-Apr,24(2):108-15.do 101177/0885066608329946.pub 2009 Feb 2
2. 重症医学科的质量、安全与规范[M].云南大学出版社；201405.600.
3. 张伟英，肖松梅，周如女，彭幼清.危重患者院内转运不良事件的研究进展[J].解放军护理杂志，2019,3601:51-54.
4. OttLK, Hofman LA, Hrawak M. intrahospitalTranspont to the Radiology Department: Risk for Adverse Events, Nursing Suneilance, Utlization of a MET andPracticeImplications JRadiol Nurs.2011 Jun:30(2):49-52 doi 10 1016/.jradnu 2011.02.001.
