Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences

BACKGROUND

Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice.

AIM

This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses.

STUDY DESIGN

This study adopted a mixed-methods approach.

METHODS

Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics.

RESULTS

Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training).

CONCLUSION

IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care.

RELEVANCE FOR CLINICAL PRACTICE

The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team.

Intrahospital Transport of Critically Ill Patients with Subarachnoid Hemorrhage-Frequency, Timing, Complications, and Clinical Consequences

BACKGROUND

Patients with subarachnoid hemorrhage (SAH) often necessitate intra-hospital transport (IHT) during intensive care treatment. These transfers to facilities outside of the neurointensive care unit (NICU) pose challenges due to the inherent instability of the hemodynamic, respiratory, and neurological parameters that are typical in these patients.

METHODS

In this retrospective, single-center cohort study, a total of 108 IHTs were analyzed for demographics, transport rationale, clinical outcomes, and pre/post-IHT monitoring parameters. After establishing clinical thresholds, the frequency of complications was calculated, and predictors of thresholds violations were determined.

RESULTS

The mean age was 55.7 (+/-15.3) years, with 68.0% showing severe SAH (World Federation of Neurosurgical Societies Scale 5). IHTs with an emergency indication made up 30.8% of all transports. Direct therapeutic consequences from IHT were observed in 38.5%. On average, the first IHT occurred 1.5 (+/-2.0) days post-admission and patients were transported 4.3 (+/-1.8) times during their stay in the NICU. Significant parameter changes from pre- to post-IHT included mean arterial pressure, systolic blood pressure, oxygen saturation, blood glucose levels, temperature, dosages of propofol and ketamine, tidal volume, inspired oxygen concentration, Horovitz index, glucose, pH, intracranial pressure, and cerebral perfusion pressure. Relevant hemodynamic thresholds were violated in 31.5% of cases, while respiratory complications occurred in 63.9%, and neurological complications in 20.4%. For hemodynamic complications, a low heart rate with a threshold of 61/min (OR 0.96, 95% CI 0.93-0.99, p = 0.0165) and low doses of midazolam with a threshold of 17.5 mg/h (OR 0.97, 95% CI 0.95-1.00, p = 0.0232) significantly predicted adverse events. However, the model did not identify significant predictors for respiratory and neurological outcomes.

CONCLUSIONS

Conclusively, IHTs in SAH patients are associated with relevant changes in hemodynamic, respiratory, and neurological monitoring parameters, with direct therapeutic consequences in 4/10 IHTs. These findings underscore the importance of further studies on the clinical impact of IHTs.

Effectiveness of the graded transport mode for the intrahospital transport of critically ill patients: A retrospective study

Aim

The purpose of this study was to evaluate the effectiveness of the graded transport mode in the intrahospital transport (IHT) of critically ill patients.

Methods

This is a retrospective study, including 800 patients and categorized them into control and observation groups. The control group included 420 critically ill patients who were transported via conventional methods from our emergency resuscitation unit from June 2017 to December 2017. The observation group included 380 critically ill patients who were transported through a graded transport mode from January 2018 to June 2018. We performed intergroup comparisons of the incidence rates and causes of adverse events (AEs), transport time, length of stay, and mortality rate.

Results

The observation group had significantly lower transport time and AE incidence rates than the control group. However, no significant differences were observed in terms of the length of stay and mortality rate between the two groups.

Conclusion

The most notable merits of the graded transport mode in the IHT of critical care patients include the fact that it significantly reduces the incidence of AEs during IHT, shortens the transport time, and improves transport efficiency, thereby ensuring the safety of critically ill patients.

Intrahospital transport of critically ill patients: A cross-sectional survey of Nurses' attitudes and experiences in adult intensive care units

AIMS

To describe adult intensive care nurses' experiences and attitudes towards intrahospital transport (IHT) of critically ill patients and to assess the relationship between nurses' characteristics, attitudes and experiences.

DESIGN

Cross-sectional survey.

METHODS

Factor analysis identified factors within the attitudinal and experience domains. Univariate analysis was performed to demonstrate the relationship between attitudinal and experience factors and demographic and professional characteristics of the participants. Multiple regression equations were applied to determine associations between nurses' experiences and attitudes. The study took place from July to August 2019.

RESULTS

A total of 480 nurses from 12 adult intensive care units in China participated, with a response rate of 65%. Most respondents had a baccalaureate nursing degree (75%). The majority (80%) had participated in IHT of critically ill more than five times in the previous 12 months and 90% agreed that checklists led to an improvement in patient safety during transport. However, 75% of respondents expressed that transport increased the workload of the nurses who accompany patients off unit and those who remained in the intensive care unit (66%). Variables that were associated with a favourable perception of transport competency and checklists/tool use were nurses' prior transport experiences and knowledge/training.

CONCLUSION

Nurses perceived IHT was a sourse of stress and increased workload. Checklists and training were beneficial for patient safety during IHT.

IMPACT

The findings point out a clear need for ICU nurse training, standardised policy/procedure and customisation of existing intrahospital transfer checklists according to hospital procedures and local circumstances. New research is needed to evaluate the impact of novel IHT interventions on patient safety and nurses' stress.

Proactive risk assessment of intrahospital transport of critically ill patients from emergency department to intensive care unit in a teaching hospital and its implications

AIMS AND OBJECTIVES

To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU).

BACKGROUND

Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs). The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed.

DESIGN

A qualitative action research study combined with a quantitative cross-sectional method.

METHODS

According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process.

RESULTS

The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work-flow alterations included use of a three-stage hierarchical transport strategy based on patients' condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p < 0.05).

CONCLUSION

Application of the HFMEA in optimising IHT process can improve the safety of transportation, which is worthy of promotion. Hierarchical transport scheme can reduce the incidence of AEs in IHT of critical emergency patients, which mainly includes the integration and construction of the transport team, equipment configuration and patient information system based on the classification of patients' condition.

RELEVANCE TO CLINICAL PRACTICE

Nurses play a crucial role in the IHT process. HFMEA can be adopted for proactive risk assessment of critically ill patients' IHT from ED to ICU which involves multiple processes. The IHT hierarchical strategy based on the results of failure mode analysis should be more widely used to further verify its clinical effects.

Detrimental effects of intrahospital transport on cerebral metabolism in patients suffering severe aneurysmal subarachnoid hemorrhage

OBJECTIVE

Intrahospital transport for CT scans is routinely performed for neurosurgical patients. Particularly in the sedated and mechanically ventilated patient, intracranial hypertension and blood pressure fluctuations that might impair cerebral perfusion are frequently observed during these interventions. This study quantifies the impact of intrahospital patient transport on multimodality monitoring measurements, with a particular focus on cerebral metabolism.

METHODS

Forty intrahospital transports in 20 consecutive patients suffering severe aneurysmal subarachnoid hemorrhage (SAH) under continuous intracranial pressure (ICP), brain tissue oxygen tension (pbtO2), and cerebral microdialysis monitoring were prospectively included. Changes in multimodality neuromonitoring data during intrahospital transport to the CT scanner and the subsequent 10 hours were evaluated using linear mixed models. Furthermore, the impact of risk factors at transportation, such as cerebral vasospasm, cerebral hypoxia (pbtO2 < 15 mm Hg), metabolic crisis (lactate-pyruvate ratio [LPR] > 40), and transport duration on cerebral metabolism, was analyzed.

RESULTS

During the transport, the mean ICP significantly increased from 7.1 ± 3.9 mm Hg to 13.5 ± 6.0 mm Hg (p < 0.001). The ICP exceeded 20 mm Hg in 92.5% of patients; pbtO2 showed a parallel rise from 23.1 ± 13.3 mm Hg to 28.5 ± 23.6 mm Hg (p = 0.02) due to an increase in the fraction of inspired oxygen during the transport. Both ICP and pbtO2 returned to baseline values thereafter. Cerebral glycerol significantly increased from 71.0 ± 54.9 µmol/L to 75.3 ± 56.0 µmol/L during the transport (p = 0.01) and remained elevated for the following 9 hours. In contrast, cerebral pyruvate and lactate levels were stable during the transport but showed a significant secondary increase 1-8 hours and 2-9 hours, respectively, thereafter (p < 0.05). However, the LPR remained stable over the entire observation period. Patients with extended transport duration (more than 25 minutes) were found to have significantly higher levels of cerebral pyruvate and lactate as well as lower glutamate concentrations in the posttransport period.

CONCLUSIONS

Intrahospital transport and horizontal positioning during CT scans induce immediate intracranial hypertension and an increase in cerebral glycerol, suggesting neuronal injury. Afterward, sustained impairment of neuronal metabolism for several hours could be observed, which might increase the risk of secondary ischemic events. Therefore, intrahospital transport for neuroradiological imaging should be strongly reconsidered and only indicated if the expected benefit of imaging results outweighs the risks of transportation.

The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic

To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019.

Design

This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group).

Setting

High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri.

PATIENTS

All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded.

Interventions

None.

Measurements and Main Results

We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001).

Conclusions

Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.

Critical events during intra-hospital transport of critically ill patients to and from intensive care unit

OBJECTIVES

Intensive care unit (ICU) patients are at an increased risk of many catastrophic events during intrahospital transport (IHT) for various procedures. This study was planned to determine the incidence and types of adverse events occurring during the transport of critically ill patients in a tertiary care hospital.

METHODS

This prospective observational study was conducted in the ICU of a tertiary care hospital for 8 months after ethical clearance from the institute ethics committee. All patients transported out of the ICU during the audit period for diagnostic or therapeutic procedures were included in the study. Vitals and several study parameters were recorded before, during, and after shifting patients to and from the ICU. Various critical events were noted during transport and classified into major and minor critical events based on the presence and absence of potential consequences that lead to a change of therapy during transport.

RESULTS

One hundred and sixty patients were studied for consecutive IHT to and from the ICU. The patients were transported for imaging studies (58.1%), minor surgery (31.8%), major surgery (2.5%), and other procedures (7.5%). A total of 248 critical events were observed in 104 IHTs (65%; 95% confidence interval [95% CI]: 57.4%-72.1%). Hence, an average of 2.38 critical events occurred per IHT. There were 31 major events among the 248 critical events (12.5%; 95% CI: 8.8%-17.1%).

CONCLUSIONS

Standard guidelines about the accompanying personnel and monitoring need to be followed during IHT. Conduct of minor surgical procedures in the ICU and better bedside diagnostic procedures may be considered for the future.

Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection

Introduction: Early magnetic resonance imaging (MRI) provides important information for management and prognosis in patients with severe traumatic brain injury (sTBI). Yet, optimal timing of MRI remains unknown. The aim of our study was to evaluate the safety of early MRI and to identify a method for appropriate patient selection to minimize adverse events related to the intrahospital transport (IHT) and the MRI examination.

Methods: Twenty-six patients with sTBI [mean Glasgow Coma Scale (GCS) 6, range 3–8] admitted to our neurosurgical ICU from 03/2015 to 12/2017 and receiving at least one MRI within the first 14 days after initial traumatic event were prospectively included in the study. The following requirements were fulfilled for at least 4 h prior to anticipated MRI: MAP > 70 mmHg, aPCO₂ 30–40 mmHg, stable ICP < 25 mmHg. All relevant cardiopulmonary and cerebral parameters and medication were recorded. The following MRI sequences were performed: DWI, FLAIR, 3D T2-space, 3D T1 MPRAGE, 3D SWI, 3D TOF, pASL, and ¹H/³¹P-MRS.

Results: Four females and 22 males (aged 23–78 years, mean 46.4 years) with a median GCS on admission of 5 (range 3–8) were analyzed. In total, 40 IHTs were performed within the first 14 days (mean 6 days, range 1–14 days). Mean pre-MRI ICP was 14.1 mmHg (range 3–32 mmHg). The mean post-MRI ICP was 14.3 mmHg (range 3–29 mmHg), decreasing to a mean ICP of 13.2 mmHg after 1 h (range 3–29 mmHg). There were no significant differences in ICP measurements before and after MRI (p = 0.30). MAP remained stable with no significant changes during the entire IHT and MRI. No other adverse events were observed as well.

Conclusion: Early MRI in acute severe TBI is feasible and safe. Yet, careful patient selection with prior adequate testing of cardiopulmonary and cerebral parameters is crucial to minimize transport- or examination-related morbidity.

Serum Biomarkers for Risk Assessment of Intrahospital Transports in Mechanically Ventilated Neurosurgical Intensive Care Unit Patients

OBJECTIVE

Intrahospital transports (IHTs) of neurosurgical intensive care unit (NICU) patients can be hazardous. Increasing intracranial pressure (ICP) and/or decreasing cerebral perfusion pressure (CPP) as well as cardiopulmonary alterations are common complications of an IHTs, which can lead to secondary brain injury. This study was performed to assess several serum biomarkers concerning their potential to improve safety of IHTs in mechanically ventilated NICU patients.

METHODS

All IHTs of mechanically ventilated and sedated NICU patients from 03/2017 to 01/2018 were retrospectively analyzed. Intracranial pressure and CPP measurements were performed in all patients. Serum hemoglobin, hematocrit, and serum sodium were defined as serum biomarkers. Demographic data, computed tomography scan on admission, Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation II, modified Rankin Scale, indication and consequence of IHTs were analyzed. Alteration of ICP/CPP, hemodynamic and pulmonary events were defined as complications. The study population was stratified into patients with the occurrence of a complication and absence of a complication.

RESULTS

We analyzed a total number of 184 IHTs in 70 NICU patients with an overall complication rate of 57.6%. Of all, 32.1% IHTs had no direct therapeutic consequence. In patients with higher hemoglobin values prior to IHT less complications occurred, concerning ICP (P = .001), CPP (P = .001), hemodynamic (P = .005), and pulmonary (P < .0001) events. In addition, complications concerning ICP (P = .001), CPP (P = .001), hemodynamic (P = .005), and pulmonary problems (P = .002) were significantly lower in patients with higher hematocrit values before IHT.

CONCLUSION

Intrahospital transports of mechanically ventilated NICU patients carry a high risk of increased ICP and hemodynamic complications and should be performed restrictively. Higher values of hemoglobin and hematocrit prior to IHT were associated with less complications with regard to ICP, CPP as well as hemodynamic and pulmonary events and could be helpful to assess the potential risk of complications prior to IHTs.

An interprofessional training program for intrahospital transport of critically ill patients: model build-up and assessment

Intrahospital transport of critically ill patients for diagnostic or therapeutic procedures can be compromised by patient instability, equipment problems or inexperienced teamworking. This quasi-experimental study aimed to assess the effectiveness of an in-situ interprofessional simulation-based training (IIST) model for junior member transport teams. Newly registered postgraduate physicians, nurses and respiratory therapists underwent the IIST. The technical skills (TS) of each participant and non-technical skills (NTS) of each interprofessional team were assessed using well-validated checklists. Thirty-six participants enrolled and were randomly assigned to six experimental and six control teams. Most participants achieved a significantly higher level of both TS and NTS. Both the control and experimental teams overvalued their NTS in the pretest, while the posttest self-assessment scores among the experimental groups more closely matched the expert assessments. Despite challenges in scheduling and the setting, the IIST was successfully conducted in a crowded hospital, which enabled trainees to optimize their learning in a real-life environment. In conclusion, the IIST model can facilitate the development of both TS and NTS for transport team members. Transport teams made up of newly registered staff from different disciplines may lack insight into their NTS in critical patient transfer management, but simulation training may cause improvements.

A Cardiopulmonary Monitoring System for Patient Transport Within Hospitals Using Mobile Internet of Things Technology: Observational Validation Study

Background

During intrahospital transport, adverse events are inevitable. Real-time monitoring can be helpful for preventing these events during intrahospital transport.

Objective

We attempted to determine the viability of risk signal detection using wearable devices and mobile apps during intrahospital transport. An alarm was sent to clinicians in the event of oxygen saturation below 90%, heart rate above 140 or below 60 beats per minute (bpm), and network errors. We validated the reliability of the risk signal transmitted over the network.

Methods

We used two wearable devices to monitor oxygen saturation and heart rate for 23 patients during intrahospital transport for diagnostic workup or rehabilitation. To determine the agreement between the devices, records collected every 4 seconds were matched and imputation was performed if no records were collected at the same time by both devices. We used intraclass correlation coefficients (ICC) to evaluate the relationships between the two devices.

Results

Data for 21 patients were delivered to the cloud over LTE, and data for two patients were delivered over Wi-Fi. Monitoring devices were used for 20 patients during intrahospital transport for diagnostic work up and for three patients during rehabilitation. Three patients using supplemental oxygen before the study were included. In our study, the ICC for the heart rate between the two devices was 0.940 (95% CI 0.939-0.942) and that of oxygen saturation was 0.719 (95% CI 0.711-0.727). Systemic error analyzed with Bland-Altman analysis was 0.428 for heart rate and –1.404 for oxygen saturation. During the study, 14 patients had 20 risk signals: nine signals for eight patients with less than 90% oxygen saturation, four for four patients with a heart rate of 60 bpm or less, and seven for five patients due to network error.

Conclusions

We developed a system that notifies the health care provider of the risk level of a patient during transportation using a wearable device and a mobile app. Although there were some problems such as missing values and network errors, this paper is meaningful in that the previously mentioned risk detection system was validated with actual patients.

Benefits of and Untoward Events during Intrahospital Transport of Pediatric Intensive Care Unit Patients

Background and Aims:

The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs) during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU.

Subjects and Methods:

Eighty critically ill pediatric (<18 years) cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study. The data collected included the destination (computed tomography scan, intervention radiology, magnetic resonance imaging scan, and operation theater), accompanying medical personnel, UEs, and benefits obtained during transport.

Results:

Among eighty pediatric patients, the median age was 8 years (range 2–17 years). During the transport, four (5%) patients required endotracheal intubation, three (3.75%) patients required intercostal drain placement, and six (7.5%) patients required cardiopulmonary resuscitation. Accidental removal of central venous catheter was reported in three (3.75%) patients, drain came out in four (5%) patients, and three (3.75%) patients had accidental extubation. Transport indirectly led to a change in antibiotic therapy in 24 (30%) patients and directly helped in change of therapy in the form of interventions in 20 (25%) patients.

Conclusion:

Critically ill children can be transported safely with adequate pretransport preparations, which may help in avoiding major UEs and benefit the patient by change in the therapy.

Complications and benefits of intrahospital transport of adult Intensive Care Unit patients

Background:

The transport of critically ill patients for procedures or tests outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. Plenty of data is available on pre- and inter-hospital transport of patients; the data on intrahospital transport of patients are limited. We audited the complications and benefits of intrahospital transport of critically ill patients in our tertiary care center over 6 months.

Materials and Methods:

One hundred and twenty adult critically ill cancer patients transported from the ICU for either diagnostic or therapeutic procedure over 6 months were included. The data collected include the destination, the accompanying person, total time spent outside the ICU, and any adverse events and adverse change in vitals.

Results:

Among the 120 adult patients, 5 (4.1%) required endotracheal intubation, 5 (4.1%) required intercostal drain placement, and 20 (16.7%) required cardiopulmonary resuscitation (CPR). Dislodgement of central venous catheter occurred in 2 (1.6%) patients, drain came out in 3 (2.5%) patients, orogastric tube came out in 1 (0.8%) patient, 2 (1.6%) patients self-extubated, and in one patient, tracheostomy tube was dislodged. The adverse events were more in patients who spent more than 60 min outside the ICU, particularly requirement of CPR (18 [25%] vs. 2 [4.2%], ≤60 min vs. >60 min, respectively) with P < 0.05. Transport led to change in therapy in 32 (26.7%) patients.

Conclusion:

Transport in critically ill cancer patients is more hazardous and needs adequate pretransport preparations. Transport in spite being hazardous may lead to a beneficial change in therapy in a significant number of patients.

Value of Computed Tomography of the Chest in Subjects With ARDS: A Retrospective Observational Study

BACKGROUND

The value of computed tomography (CT) of the chest in the management of patients with ARDS is poorly defined. The aim of this study was to assess the clinical utility of thoracic CT scans in subjects with ARDS using the Berlin definition.

METHODS

This was a retrospective, observational study in a university hospital ARDS center on all subjects with ARDS in whom a CT scan of the chest was performed immediately before or during an ICU stay between January 1, 2007 and June 30, 2013.

RESULTS

During the study period, a total of 1,781 thoracic CT scans were performed, of which 204 cases met inclusion criteria. The most common pathologic findings of the lung parenchyma were consolidations (94.1% of cases) and ground glass opacities (85.3%). Furthermore, CT scans showed pleural effusions (80.4%), mediastinal lymphadenopathy (66.7%), signs of right ventricular strain and pulmonary hypertension (53.9%), pericardial effusion (37.3%), emphysema of the chest wall (12.3%), pneumothorax (11.8%), emphysema of the mediastinum (7.4%), and pulmonary embolism (2.5%). Results of CT scans led to changes in management in 26.5% of cases. Mortality was significantly increased in subjects with involvement of lung parenchyma of >80% (P = .004). Intrahospital transport was associated with critical incidents in 8.3% of cases.

CONCLUSIONS

Systematic evaluation of thoracic CT scans yielded information useful for making a diagnosis, predicting prognosis, and recognizing concomitant disorders requiring therapeutic interventions. Results obtained from CT scans led to changes in management in 26.5% of cases.

Intrahospital transport of mechanically ventilated intensive care patients using new equipment attached to a transfer board

Aim

Multiple lines and tubes often complicate bed transfer in critically ill patients. To solve this problem, the authors developed medical equipment attached to a transfer board ("transfer board tree") that integrates the patient, transfer board, and medical equipment. The objective of this study was to evaluate the efficiency and safety of the transfer board tree.

Methods

Forty mechanically ventilated patients (20 transfer board tree, 20 conventional) in the intensive care unit who were transported for computed tomography were enrolled. Transfer times and adverse events were recorded.

Results

Transfer board tree patients had significantly shorter transfer times. There were two adverse events only in the conventional group.

Conclusions

The transfer board tree enables rapid intrahospital transport of intensive care patients with sufficient monitoring.

Medical emergency team calls in the radiology department: patient characteristics and outcomes

OBJECTIVE

We sought to identify the characteristics of patients who experience medical emergency team calls in the radiology department (MET-RD) and the relationship between these characteristics and patient outcomes.

DESIGN/PARTICIPANTS

Retrospective review of 111 inpatient MET-RD calls (May 2008-April 2010).

SETTING

Academic medical centre with a well established MET system.

MEASUREMENTS

The characteristics of patients before, during and after transport to radiology were extracted from medical records and administrative databases. These characteristics were compared between patients with good and poor outcomes.

MAIN RESULTS

The majority of patients who experience MET-RD calls had a Charlson Comorbidity Index ≥4 and were from non-intensive care units (60%). Almost half (43%) of MET-RD calls occurred during patients' first day in hospital. Patients commonly arrived with nasal cannula oxygen (38%), recent tachypnoea (28%) and tachycardia (34%). A minority (16%) fulfilled MET call criteria in the 12 h before the MET-RD. MET-RD etiologies were cardiac (41%), respiratory (29%) or neurological (25%), and occurred most frequently during CT (44%) and MRI (22%) testing. Post MET-RD, the majority of patients (70%) required a higher level of care. Death before discharge (25%) was associated with need for cardiovascular support prior to RD transport (p=0.02), need for RD monitoring (p=0.02) and need for heightened RD surveillance (p=0.04).

CONCLUSIONS

The majority of patients who experienced MET-RD calls came from non-intensive care units, with comorbidities and vital sign alterations prior to arrival at the RD. Risk appeared to be increased for those requiring CT and MRI. These findings suggest that prior identification of a subset of patients at risk of instability in the RD may be possible.

Intrahospital transport of critically ill patients

BACKGROUND

This review on the current literature of the intrahospital transport of critically ill patients addresses type and incidence of adverse effects, risk factors and risk assessment, and the available information on efficiency and cost-effectiveness of transferring such patients for diagnostic or therapeutic interventions within hospital. Methods and guidelines to prevent or reduce potential hazards and complications are provided.

METHODS

A Medline search was performed using the terms 'critical illness', 'transport of patients', 'patient transfer', 'critical care', 'monitoring' and 'intrahospital transport', and all information concerning the intrahospital transport of patients was considered.

RESULTS

Adverse effects may occur in up to 70% of transports. They include a change in heart rate, arterial hypotension and hypertension, increased intracranial pressure, arrhythmias, cardiac arrest and a change in respiratory rate, hypocapnia and hypercapnia, and significant hypoxaemia. No transport-related deaths have been reported. In up to one-third of cases mishaps during transport were equipment related. A long-term deterioration of respiratory function was observed in 12% of cases. Patient-related risk indicators were found to be a high Therapeutic Intervention Severity Score, mechanical ventilation, ventilation with positive end-expiratory pressure and high injury severity score. Patients' age, duration of transport, destination of transport, Acute Physiology and Chronic Health Evaluation II score, personnel accompanying the patient and other factors were not found to correlate with an increased rate of complications. Transports for diagnostic procedures resulted in a change in patient management in 40-50% of cases, indicating a good risk:benefit ratio.

CONCLUSIONS

To prevent adverse effects of intrahospital transports, guidelines concerning the organization of transports, the personnel, equipment and monitoring should be followed. In particular, the presence of a critical care physician during transport, proper equipment to monitor vital functions and to treat such disturbances immediately, and close control of the patient's ventilation appear to be of major importance. It appears useful to use specifically constructed carts including standard intensive care unit ventilators in a selected group of patients. To further reduce the rate of inadvertent mishaps resulting from transports, alternative diagnostic modalities or techniques and performing surgical procedures in the intensive care unit should be considered.

Road trips and resources: there is a better way

BACKGROUND: Transport of critically ill patients for diagnostic and/or therapeutic management involves significant consumption of resources. In an effort to improve the delivery of care to these patients and decrease resource utilization, Hill-Rom (Batesville, IN, USA) have developed a self-contained device (CarePorterTM) designed to provide both intensive care unit (ICU) support and transport capability. We hypothesized that the use of the CarePorter when compared with a standard or specialty bed (with transfer to a stretcher) would decrease the number of personnel and time required for transport without altering the current ICU standards of care. RESULTS: Over a 3 month period, 35 ventilated patient transports were divided into the following groups: specialty bed to stretcher (n = 13), standard bed (n = 9) and CarePorter (n = 13). The APACHE II score at the time of transport was not different between the groups, nor was the ongoing care being delivered. The CarePorter group had a statistically greater fractional inspiration of oxygen and positive end expiratory pressure, when compared with the other two groups (P < 0.05). The use of the CarePorter device decreased the number of personnel required to transport a patient (2.1 +/- 0.3 vs 3.6 +/- 0.5 for the standard bed and and 3.2 +/- 0.7 for the specialty bed; P = 0.0001). The CarePorter also decreased the number of resources utilized for the preparation of a patient for transport (P = 0.001) when compared to the other groups. This was primarily due to the transfer of patients from specialty beds to a stretcher. Overall respiratory therapy time was also much less with the CarePorter (5.9 +/- 5.7 min), when compared with the standard (26 +/- 10 min) or specialty bed (22 +/- 11 min) (P = 0.0008). In addition, the CarePorter group also had a higher nursing satisfaction score with the overall transport (P = 0.008). CONCLUSIONS: Use of the CarePorter device resulted in maximization of the delivery of patient care, time savings, significantly improved utilization of escort personnel