Impact of a Designated Intrahospital Transport Team
ABSTRACT & COMMENTARY
Synopsis: A specially trained ICU nurse transport team resulted in a low rate of complications compared to national studies, and saved costs from on-call time.
Source: Stearley, HE. Am J Crit Care 1998;7:282-287.
To test the efficacy of a specially trained nursing transport team, Stearley prospectively documented patient status, medications administered, and complications during 237 consecutive intrahospital transports (92% adults; 8% children) over a six-month interval. The hospital was a 375-bed level 1 trauma center with nine ICUs. ICUs accounted for 27% of the patient population. Transport was the responsibility of a "stat nurse" who was specially trained for this role, including certification in advanced cardiac and pediatric life support. One stat nurse was assigned to each day and evening shift. If patients required mechanical ventilation, a respiratory therapist was present during transport. Resident physicians attended the transport of unstable patients.
Complications were categorized as minor (transient change, medications not required), moderate (managed with medications), or severe (did not respond to intervention). Of patients transported, 109 (49%) were mechanically ventilated. There was a 15.5% overall complication rate, with 10.2% minor, 2.5% moderate, and 2.8% resulting in severe complications. No medications or therapies were delayed. Only two (0.8%) patients had decompensation requiring the examinations to be aborted. One adult patient had a seizure, and a second had a marked drop in blood pressure while undergoing angiography to rule out an aortic tear. None of the 18 children experienced significant changes in physical status or missed scheduled therapies or medications. Stearley estimated that the approach saved almost $67,000 annually because the stat nurse assisted other personnel when not involved in transport. This assistance allowed the hospital to decrease on-call time and alleviate staffing crises.
COMMENT BY LESLIE A. HOFFMAN, RN, PhD
Reported national complication rates for intrahospital transportation of patients vary widely, depending on how the complications are defined. Potential adverse events include delayed administration of medications, significant changes in vital signs, dislodgement of airways and IV catheters, and cardiopulmonary arrest. There is agreement that transport is safest if patients are accompanied by a highly competent team who can prevent or quickly treat any adverse events.
This study differed in its use of a specially trained nurse to accompany all pediatric and adult transfers during a shift, rather than using ICU nursing staff from the floor. During the six-month data collection interval, only seven of the 237 patients experienced complications rated as severe. These were a major (> 20 mmHg above baseline) elevation in blood pressure that did not respond to therapy (n = 5), a seizure (n = 1), and marked hypotension in a patient with an aortic tear (n = 1). Thus, the approach appeared to work well. A negative in judging efficacy of the system is that no information was provided regarding severity of illness (e.g., APACHE classification). Consequently, it is difficult to judge the overall acuity of the sample.
Of importance in today's cost-conscious environment, the stat nurse had other duties when not transporting patients. This nurse carried a pager and responded to units' requests on the basis of a predetermined priority schedule e.g., code blue, transportation of ICU patients, ICU postoperative recoveries, ICU bedside procedures, ICU admissions, troubleshooting of equipment, provision of expert consultation, and IV therapy for general units. Availability of the stat nurse prevented other ICU nurses from leaving the floor, which helped to maintain staffing, and the stat nurse helped in other ways when not involved in transport, creating an overall cost savings. On average, transportation of patients accounted for 50% of the duties of the stat nurse. Findings of this study strongly support use of a specially trained team, such as a stat nurse, to assist with intrahospital transport.
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