Preparation and Implementation of Intrahospital Transfer Protocol for Emergency Department Patients to Decrease Unexpected Events
Abstract
Introduction: Most of the patients hospitalized in the emergency department (ED) are in need of transfer to other hospital wards or paraclinic units. This process is called intrahospital transfer (IHT) that may lead to a wide range of complications known as unexpected events (UE). Objective: In the present study we decided to evaluate the effect of using a pre-designed protocol on decrease of UEs and safety improvement of IHT among patients hospitalized in ED. Method: The present cross-sectional study was carried out in 2016 in the ED of Imam Khomeini Hospital, Tehran, Iran. All patients with triage levels of 1 and 2 who were in need of temporary or permanent transfer to other departments of the studied treatment center based on clinical indication as decided by the in-charge physician were enrolled in the study. This study was conducted in 3 phases of pre-intervention, intervention and post-intervention. Any UE was recorded in first phase. During intervention phase ED-IHT protocol was prepared and implemented. the checklist of complications and UEs during transfer was filled again and pre- and post-intervention results were compared. Results: In this study, 207 patients with the mean age of 58.9 ± 20.6 years were evaluated (61.4% male). Demographic data and baseline characteristics of the studied patients in the phases before and after implementation of the protocol has no significant difference. Overall, before implementation of the protocol out of the 105 studied patients, a total of 35 patients (33.3%) were affected by UE during transfer, but after implementation of the protocol this rate decreased to 11 patients (10.8%) out of the 103 studied patients and this decrease was statistically significant (p < 0.001). Conclusion: Based on the results obtained from this study, it seems that performing the IHT protocol specialized for ED patients has been effective in decreasing UE cases.
2. Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Crit Care. 2010;14(3):R87.
3. Bercault N, Wolf M, Runge I, Fleury JC, Boulain T. Intrahospital transport of critically ill ventilated patients: a risk factor for ventilator-associated pneumonia--a matched cohort study. Crit Care Med. 2005;33(11):2471-8.
4. Lovell M, Mudaliar M, Klineberg P. Intrahospital transport of critically ill patients: complications and difficulties. Anaesth Intensive Care. 2001;29(4):400-5.
5. Zuchelo L, Chiavone P. Intrahospital transport of patients on invasive ventilation: cardiorespiratory repercussions and adverse events. J Bras Pneumol. 2009;35(4):367-74.
6. Lahner D, Nikolic A, Marhofer P, Koinig H, Germann P, Weinstabl C, et al. Incidence of complications in intrahospital transport of critically ill patients – experience in an Austrian university hospital. Wien Klin Wochenschr. 2007;119(13-14):412-6.
7. Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients. Intensive Care Med. 2004;30(8):1579-85.
8. Papson JP, Russell KL, Taylor DM. Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med. 2007;14(6):574-7.
9. Kue R, Brown P, Ness C, Scheulen J. Adverse clinical events during intrahospital transport by a specialized team: a preliminary report. Am J Crit Care. 2011;20(2):153-62.
10. Day D. Keeping patients safe during intrahospital transport. Crit Care Nurse. 2010;30(4):18-32.
11. Ligtenberg JJ, Arnold LG, Stienstra Y, van der Werf TS, Meertens JH, Tulleken JE, et al. Quality of interhospital transport of critically ill patients: a prospective audit. Crit Care. 2005;9(4):R446.
12. Shirley PJ, Bion JF. Intra-hospital transport of critically ill patients: minimising risk. Intensive Care Med. 2004;30(8):1508-10.
13. Quenot J-P, Milési C, Cravoisy A, Capellier G, Mimoz O, Fourcade O, et al. Intrahospital transport of critically ill patients (excluding newborns) recommendations of the Société de Réanimation de Langue Française (SRLF), the Société Française d'Anesthésie et de Réanimation (SFAR), and the Société Française de Médecine d'Urgence (SFMU). Ann Intensive Care. 2012;2(1):1-6.
14. Warren J, Fromm REJ, Orr RA, Rotello LC, Horst HM, Medicine ACoCC. Guidelines for the inter- and intrahospital transport of critically ill patients*. Crit Care Med. 2004;32(1):256-62.
15. Medicine ACfE, Anaesthetists AaNZCo, Medicine JFoIC. Minimum standards for transport of critically ill patients. Emerg Med. 2003;15(2):197-201.
16. Minimum standards for intrahospital transport of critically ill patients. Emerg Med. 2003;15(2):202-4.
17. Medicine Io. Hospital-based emergency care: at the breaking point. Washington, DC: National Academies Press. 2006.
18. Sun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med. 2000;35(5):426-34.
19. Choi HK, Shin SD, Ro YS, Kim DK, Shin SH, Kwak YH. A before-and after-intervention trial for reducing unexpected events during the intrahospital transport of emergency patients. Am J Emerg Med. 2012;30(8):1433-40.
20. Jarden RJ, Quirke S. Improving safety and documentation in intrahospital transport: development of an intrahospital transport tool for critically ill patients. Intensive Crit Care Nurs. 2010;26(2):101-7.
21. Wiegersma JS, Droogh JM, Zijlstra JG, Fokkema J, Ligtenberg J. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team. Crit Care. 2011;15(1):R75.
Files | ||
Issue | Vol 2 No 3 (2018): Summer (July) | |
Section | Original article | |
PMCID | PMC6549197 | |
PMID | 31172092 | |
Keywords | ||
Complications Emergency department Medical audit Patient care Patient transfer |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |