Service improvement articleImproving safety and documentation in intrahospital transport: Development of an intrahospital transport tool for critically ill patients
Section snippets
Background
Critically ill patients require transportation out of the ICU for diagnostic imaging and various procedures. Often referred to as intrahospital transports, these journeys beyond the Intensive Care Unit (ICU) may include transport for magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine imaging, angiography, and gastrointestinal contrast studies. Shirley and Bion (2004) suggest these transfers occur with more frequency than interhospital transfers.
Intrahospital transfers
Context
The concept of an intrahospital transport tool was conceived in the context of a 14-bed general ICU in a New Zealand regional hospital providing tertiary care facilities. A pilot study was conducted which evaluated the number and outcome of patients who were transferred to either the CT scanner or for MRI studies. In one month in 2008, 57 patients were transferred. A review of reportable events related to intrahospital transfers took place. In addition, a review of current practice associated
Literature review
Our review of the literature focused on the intrahospital transfer of critically ill patients. Key search words included: Intensive Care Unit, Critical Care, transfer, intrahospital transport, guideline, and framework. Database searches included: Medline, CINAHL and Proquest. Boolean functions, truncation searches, and reference lists from relevant publications were reviewed without set limiters. An Internet search using the same Keywords in Google Scholar was also conducted.
A key finding from
The transport tool
Current intrahospital transport standards and guidelines were considered in the development of the transport record, particularly addressing pre-transport preparation and assessment of the patient, and ongoing monitoring and management considerations. However, this transport guideline and record should not draw attention away from the need to have trained transport staff with well designed and maintained equipment, which can facilitate the provision of safe intrahospital transport.
Format of the tool
The transport tool is a double sided, A4 document, which encompasses four key areas of the transport process: preparation, assessment, monitoring, and documentation (see Box 1, Box 2). The tool utilises a pre-transport checklist, a patient assessment form, a destination checklist, an observation chart, and sections for documentation of transport complications, and a reminder to recheck equipment and oxygen. Pre-transport preparation is addressed via a checklist format on side one of the record
Assessment
In the development of the transport tool, two patient assessment approaches were considered; the ‘A-B-C-D-E’ framework and a ‘head-to-toe’ assessment. Use of a systematic framework and accurate assessment skills are already within the domain of an ICU nurse's practice. ‘Head-to-toe’ assessment of the critically ill patient is an essential documented requirement at the beginning of each shift within one ICU, and is widely supported throughout physical examination literature as a means of
Evaluation of the transport tool and opportunities for future development
This intrahospital transport tool was incorporated into nursing practice within one ICU in February 2008. Initial feedback suggested that nurses new to the ICU willingly and frequently use the transport tool. In July 2009, ICU nurses’ use of the transport tool was evaluated through an audit. This particularly focussed on nurses’ perceptions of the tool and a documentation review.
The evaluation identified three key areas in the delivery of patient care that have been enhanced through the use of
Conclusion
The development of an intrahospital transport tool to mitigate the risk associated with intrahospital transport of the critically ill patient has been described. This tool provides the Intensive Care Unit (ICU) nurse with an integrated documentation record, incorporating patient assessment with a procedural guideline. The result is a framework for the ICU nurse to use through intrahospital transfers, informing and supporting them to provide continuity of nursing care. A context and literature
Conflict of interest statement
The authors are not aware of any conflict of interest.
Acknowledgements
The authors acknowledge Aaron Jarden, Anne Butt and Thomas Andrews.
References (37)
- et al.
Clinical guidelines for the use of the prone position in acute respiratory distress syndrome
Intensive and Critical Care Nursing
(2001) - et al.
Developing a pain assessment tool for use by nurses in an adult intensive care unit
Intensive and Critical Care Nursing
(2002) - et al.
Intrahospital transportation: monitoring and risks
Intensive and Critical Care Nursing
(1996) - et al.
Respiratory assessment in critical care units
Intensive & Critical Care Nursing
(1999) - et al.
Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia
Chest
(1997) Clinical aspects of aeromedical transport
Current Anaesthesia and Critical Care
(2003)Practical aspects of aeromedical transport
Current Anaesthesia and Critical Care
(2003)Which nursing issues need a European guideline: proposal for respiratory management
Intensive and Critical Care Nursing
(2004)- et al.
Impact of introducing a sedation management guideline in intensive care
Anesthesia
(2006) Preparing patients for aeromedical transport
Journal of Emergency Nursing
(1987)
Developing rigour in observation of the sick child
Paediatric Nursing
Incidents relating to the intra-hospital transfer of critically ill patients: an analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care
Intensive Care Medicine
Bates’ guide to physical examination and history taking
Intrahospital transport: a framework for assessment
Critical Care Nursing Quarterly
Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems
Emergency Medicine Journal
Air and surface patient transport: principles and practice
Risk, cost, and benefit of transporting ICU patients for special studies
The Journal of Trauma
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