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Quality of interhospital transport of critically ill patients: a prospective audit.

机译：重症患者医院间运输的质量：前瞻性审核。

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INTRODUCTION: The aim of transferring a critically ill patient to the intensive care unit (ICU) of a tertiary referral centre is to improve prognosis. The transport itself must be as safe as possible and should not pose additional risks. We performed a prospective audit of the quality of interhospital transports to our university hospital-based medical ICU. METHODS: Transfers were undertaken using standard ambulances. On departure and immediately after arrival, the following data were collected: blood pressure, heart rate, body temperature, oxygen saturation, arterial blood gas analysis, serum lactic acid, plasma haemoglobin concentration, blood glucose, mechanical ventilation settings, use of vasopressor/inotropic drugs, and presence of venous and arterial catheters. Ambulance personnel completed forms describing haemodynamic and ventilatory data during transport. Data were collected by our research nurse and analyzed. RESULTS: A total of 100 consecutive transfers of ICU patients over a 14-month period were evaluated. Sixty-five per cent of patients were mechanically ventilated; 38% were on vasoactive drugs. Thirty-seven per cent exhibited an increased number of vital variables beyond predefined thresholds after transport compared with before transport; 34% had an equal number; and 29% had a lower number of vital variables beyond thresholds after transport. The distance of transport did not correlate with the condition on arrival. Six patients died within 24 hours after arrival; vital variables in these patients were not significantly different from those in patients who survived the first 24 hours. ICU mortality was 27%. Adverse events occurred in 34% of transfers; in 50% of these transports, pretransport recommendations given by the intensivist of our ICU were ignored. Approximately 30% of events may be attributed to technical problems. CONCLUSION: On aggregate, the quality of transport in our catchment area carried out using standard ambulances appeared to be satisfactory. However, examination of the data in greater detail revealed a number of preventable events. Further improvement must be achieved by better communication between referring and receiving hospitals, and by strict adherence to checklists and to published protocols. Patients transported between ICUs are still critically ill and should be treated as such.
机译：简介：将重症患者转移到三级转诊中心的重症监护病房（ICU）的目的是改善预后。运输本身必须尽可能安全，并且不应构成其他风险。我们对医院以医院为基础的医疗ICU的运输质量进行了前瞻性审核。方法：使用标准救护车进行接送。起飞时和抵达后不久，收集了以下数据：血压，心率，体温，氧饱和度，动脉血气分析，血清乳酸，血浆血红蛋白浓度，血糖，机械通气设置，使用升压药/正性肌力药药物，以及静脉和动脉导管的存在。救护人员填写了运输过程中描述血流动力学和通气数据的表格。由我们的研究护士收集数据并进行分析。结果：评估了在14个月内总共100次连续ICU患者的转移。 65％的患者进行了机械通气; 38％的患者使用血管活性药物。与运输前相比，运输后有37％的生命变量超出了预定的阈值; 34％的人数相等;在运输后，有29％的患者的生命变量数量低于阈值。运输距离与到达条件无关。六名患者在抵达后24小时内死亡;这些患者的生命变量与最初24小时存活的患者无明显差异。 ICU死亡率为27％。不良事件发生在转移的34​​％中;在这些运输的50％中，我们ICU的专科医生提出的运输前建议被忽略了。大约30％的事件可能归因于技术问题。结论：总的来说，使用标准救护车在我们集水区的运输质量似乎令人满意。但是，更详细地检查数据显示了许多可预防的事件。必须通过在转诊医院和接收医院之间进行更好的沟通，并严格遵守检查表和已发布的协议来实现进一步的改进。在重症监护病房之间转运的患者仍然危重，应照此治疗。

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