Intrahospital transport

Transport of critically ill patient in hospital is a great task and requires, a well trained team and if not carried out with precision can lead to life threatening accidents..

1. Transport of Critically ill Patients Lt Col A K Singh Classified Specialist Anaesthesiology Dept of Anaesthesiology & Critical Care

2. Issues of intra-hospital transport Minimum Standards for Intra-hospital . Transport of Critically Ill Patients

3. INTRODUCTION Critically ill patients may have absent or small physiological reserves. Adverse physiological changes during transport are common and can be life-threatening. Ventilator-dependent and haemodynamically unstable patients are at particular risk. Careful planning is required to shift these pts in hospital facilities such as operating theatres ICU, Emergency Department, imaging rooms, wards.

4. Intra-hospital transport is usually Elective, Emergency like to the operating theatres after a diagnostic procedure for surgery.

5. 1. PROTOCOL Formulate hospital’s protocol of intra-hospital transport of critically ill patients. Protocol widely known and available. The transport must be justified. Benefits of proposed interventions must outweigh Risks of moving the critically ill patient Those posed by the interventions themselves.

6. EQUIPMENT Dedicated to intra- hospital transport. Durable, and trolley-linked devices . Able to enter lifts and pass through all doorways en route. Able to function in the specific intervention area (e.g. a magnetic resonance imaging room) Facilities for remote patient monitoring. Gas, suction, and electrical supplies at the destination must be present and compatible.

7. EQUIPMENT Equipment should not be placed on the patient; Specially designed receptacles or transport trolleys are useful. Basic monitoring ECG, heart rate, Blood pressure (by invasive or an automated non-invasive monitor), Oxygen saturation by pulse oximetry Must be used for all patients. A capnometer must be used to monitor all patients receiving mechanical ventilation. Defibrillator and a suctioning device must be available.

8. EQUIPMENT A portable ventilator with a disconnect alarm is required for ventilator dependent patients. Manual resuscitator bag must be available. PEEP and different modes of ventilation should be available. Infusion pumps for accurate administration of drug infusions. Alarms set with appropriate limits ,to detect any hemodynamic instability. Fully charged, spare battery packs for electrically driven devices.

9. Equipment to secure the airway, Emergency drugs, Analgesics, Sedatives, Muscle relaxants. Ensure that all intra-hospital transport equipment is readily accessible and regularly checked.

10. STAFFING Key personnel for each transport event should be identified. The transport team should consist at least of an appropriately Qualified nurse, An orderly, Trained doctor. Each team must be familiar with the equipment and be sufficiently experienced with Securing airways, Ventilation of the lungs, Resuscitation, Other anticipated emergency procedures.

11. PRE-DEPARTURE PROCEDURES The transport team must be freed from other duties. The receiving person or staff at the destination must be notified, and the arrival time must be clearly understood. All pieces of equipment must be checked, and notes and imaging films gathered. Individual responsibilities for checking equipment must be defined.

12. Checklist . Monitors function, Alarm limits are set appropriately. Manual resuscitator bag functions properly. Ventilator (if used) functions properly; Respiratory variables and alarms are set appropriately. Suction device functions properly.

13. Checklist Oxygen (± air) cylinders are full. Spare oxygen cylinder is available. Airway and intubation equipment are all available and working. Emergency drugs, analgesics, sedatives, and muscle relaxants are all available.

14. Checklist Additional drugs are made available if indicated. Spare IV fluids, inotropic solutions, or blood are available. Spare batteries are available for all battery-powered equipment. Chest tube clamps (if an underwater chest drain is present) are available. Patient notes, imaging films, and necessary forms (especially the informed consent form) are available.

15. PATIENT STATUS Final preparation of the patient should be made before the actual move, Conscious anticipation of clinical needs. appropriate doses of muscle relaxants or sedatives, replacing near-empty inotropic and other IV solutions with fresh bags, emptying drainage bags.

16. PATIENT STATUS The patient must be reassessed before transport begins, especially after being placed on monitoring equipment and the transport ventilator (if used). Transport preparations must not overshadow or neglect the patient's fundamental care. An example of is listed below. Airway is secured and patent.

17. Brief check on the patient Airway is secured and patent. Ventilation is adequate; respiratory variables are appropriate. All equipment alarms are switched on. Patient is haemodynamically stable. Vital signs are displayed on transport monitors and are clearly visible to transport staff.

18. Brief check on the patient PEEP/CPAP (if set) and FIO2 levels are correct. All drains (urinary, wound, or underwater seal) are functioning and secured. Underwater seal drain is not clamped. Venous access is adequate and patent. IV drips and infusion pumps are functioning properly. Patient is safely secured on trolley.

19. IN-TRANSIT PROCEDURES A best route should be planned. Lifts should be secured or reserved beforehand. Adequate communication facilities during transit and at the destination must be available. The status of the patient must be checked at intervals, especially if the journey takes considerable time. Any change in the patient's condition, unexpected event, or critical incident, must be acted upon immediately.

20. ARRIVAL PROCEDURES On arrival at the destination , receiving monitoring, ventilation, gas, suction, power facilities are checked if the patient is to be transferred from the transport facilities. Before shifting ensure. monitors, ventilators (if used), gas power supplies are established.

21. If another team assumes responsibility of care, a complete hand over is given to the team leader. The transport staff must remain with the patient until the receiving team is fully ready to take over care.

22. DOCUMENTATION The clinical record should document the patient’s clinical status during transport until handover occurs at the destination. He must record also after transport.

23. QUALITY ASSURANCE The process of intra-hospital transport of patients should be continually evaluated to identify system problems and recommend improvements.

24. THANK YOU