Service improvement article
Improving safety and documentation in intrahospital transport: Development of an intrahospital transport tool for critically ill patients

https://doi.org/10.1016/j.iccn.2009.12.007Get rights and content

Summary

Transporting the critically ill patient is described within the literature as a high-risk procedure. Both guidelines and minimum standards are available to inform practice. However, a practical, clinically useful, and evidence-based document (tool) for the ICU nurse to use when transporting a critically ill patient was not identified in the literature. Consequently, the development of an intrahospital transport tool is described. This transport tool was designed to mitigate the risks associated with patient transport by providing 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 throughout intrahospital transfers, informing and supporting them to provide and document continuity of nursing care. The potential benefit of using this tool is enhanced patient outcomes through safer ICU intrahospital transport processes.

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.

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