Anesthesia Patient Safety Podcast
The official podcast of the Anesthesia Patient Safety Foundation (APSF) is hosted by Alli Bechtel, MD, featuring the latest information and news in perioperative and anesthesia patient safety. The APSF podcast is intended for anesthesiologists, anesthetists, clinicians and other professionals with an interest in anesthesiology, and patient safety advocates around the world.
The Anesthesia Patient Safety Podcast delivers the best of the APSF Newsletter and website directly to you, so you can listen on the go! This includes some of the most important COVID-19 information on airway management, ventilators, personal protective equipment (PPE), drug information, and elective surgery recommendations.
Don't forget to check out APSF.org for the show notes that accompany each episode, and email us at podcast@APSF.org with your suggestions for future episodes. Visit us at APSF.org/podcast and at @APSForg on Twitter, Facebook, and Instagram.
Anesthesia Patient Safety Podcast
#258 Wheels of Risk: When Patient Safety Rolls Through Hospital Corridors
The journey between hospital departments can be the most dangerous part of a patient's perioperative experience. This eye-opening episode dives deep into the hidden risks of intra-hospital patient transport. We examine the current literature on transport safety with particular focus on the challenges faced by anesthesia professionals. The data is sobering — between 4-9% of transported patients require medical intervention due to transport-related complications. With increasing production pressure, decreased support personnel, and rising patient acuity, we ask the critical question: are we transporting patients safely?
We break down transport-related adverse events into essential categories: respiratory, cardiovascular, neurological, and equipment-related. The 2023 I-TOUCH study provides valuable insights, showing cardiac events, respiratory complications, neurologic issues, and equipment problems as the most common challenges during transport. We explore how patient factors (age, illness severity, ventilation requirements) and system factors (transport duration, communication gaps, staff experience) contribute to these risks.
Beyond patient safety, we discuss the often-overlooked physical risks to anesthesia professionals themselves, who report high rates of work-related musculoskeletal injuries from maneuvering heavy transport equipment while managing patient care. The good news? Evidence-based guidelines exist to mitigate these risks. Join us next week as we continue this crucial conversation with practical recommendations from the American College of Critical Care Medicine and the Society of Critical Care Medicine for safer perioperative patient transport.
Have you experienced challenges during patient transport? Share your experiences and learn from colleagues by emailing podcast@apsf.org or visiting apsf.org for more resources on perioperative safety.
For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/258-wheels-of-risk-when-patient-safety-rolls-through-hospital-corridors/
© 2025, The Anesthesia Patient Safety Foundation
You're listening to the Anesthesia Patient Safety Podcast, the official podcast of the Anesthesia Patient Safety Foundation. We're bringing you the very best from the APSF newsletter and website, as well as the latest information in perioperative patient safety. Thanks for joining us.
Speaker 2:Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel and I'm your host. Thank you for joining us for another show. When was the last time that you were involved in transporting your patient from the operating room to the ICU or from the emergency department to radiology and then to the operating room? Anesthesia professionals are often involved in inter-hospital patient transport. There are not many studies that focus on the outcomes of patients who need to undergo perioperative transport accompanied by anesthesia professionals. Most of the literature on inter-hospital transport involves nurses and other care providers and does not focus on the perioperative population. Today, we are going to review the current literature and lessons learned from critical care and emergency medicine for how to keep patients safe during perioperative patient transport. Before we dive further into the episode today, we'd like to recognize Draeger Medical, a major corporate supporter of APSF. Draeger Medical has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, draeger Medical. We wouldn't be able to do all that we do without you.
Speaker 2:We are returning to the February 2025 APSF newsletter. Today, our featured article is Intra-Hospital Patient Transport Checklists Adverse Events and other considerations for the anesthesia professional by Caroline Andrew and Michael Fitzsimmons To follow along with us. Head over to apsforg and click on the newsletter heading First. One down is the current issue, then scroll down until you get to our featured article today. You can also find this article in the newsletter archive section. I will include a link in the show notes as well.
Speaker 2:We often talk about threats to anesthesia patient safety that may arise in the operating room. Today we are going to focus on all the areas outside of the operating room where patients may need to be transported and where they are at risk for intra-hospital adverse events during transport or within 24 hours of transport. Did you know that the incidence of these adverse events is almost 80%? In addition, the frequency of patients requiring medical intervention from intra-hospital adverse events during transport is between 4-9%. The risk of perioperative patient transport has likely increased over the years with increased production pressure, decreased support personnel and increased patient acuity. And increased patient acuity.
Speaker 2:The APSF authors are asking the critical question is our approach to perioperative patient transport right and are we doing it safely? These are great questions let's discuss. We are going to start with some definitions. Definitions for adverse events during transport include the following any unintended event or outcome which may have or did reduce the safety margin for the patient, or perhaps any observation that fell outside of a predefined threshold, such as hypotension with systolic blood pressure less than 100 millimeters of mercury, or hypertension with systolic blood pressure less than 100 millimeters of mercury, or hypertension with systolic blood pressure greater than 160 millimeters of mercury. These very different definitions means that it is hard to figure out the actual incidence of these adverse events during transport.
Speaker 2:The 2022 article Adverse Events During Intrahospital Transport of Critically Ill Patients a Systemic Review and Meta-Analysis offers some important insights. This study looked at safety and adverse events during intrahospital transport of critically ill patients and included over 12,000 transports and almost 2,000 patients over 24 studies. Results included 26% pulled frequency of all adverse events, with high heterogeneity, and pulled frequency of death due to inter-hospital transport and life-threatening adverse events was 0% and 1.47% respectively, with high heterogeneity. Due to this high heterogeneity, it was difficult to accurately determine the incidence of intra-hospital transport adverse events. Some of the studies did not clearly define these events or the definition was based on author-team consensus. These events or the definition was based on author-team consensus. Another consideration is that patient changes during transport could represent adverse events or physiologic variability that happened to occur during transport. It may be challenging to distinguish between these two as well.
Speaker 2:We have raised some important questions, but let's turn our attention to what we know about interhospital transport adverse events. These events may be categorized as respiratory, cardiovascular, neurological and equipment-related. Reported adverse events include the following hypertension, hypotension, arrhythmias, including cardiac arrest, decreased arterial saturation and agitation. Equipment-related adverse events may involve equipment malfunction, accidental dislodgement of lines, tubes and catheters, or empty oxygen cylinders. Check out the iTouch study published in 2023. This was a multicenter prospective observational study of almost 900 patients and about 1,000 transports. Out of the intensive care unit, 102 adverse events occurred during the study time period. Adverse events occurred during the study time period and the most common adverse events included 30% cardiac, 17% airway or respiratory, 16% neurologic and 12% equipment problems. The authors conclude that stabilization of patients before transport and using a standardized protocol may help decrease these events and improve patient safety. The citation is in the show notes so that you can check out the entire article.
Speaker 2:Equipment-related adverse events may be even more common up to one-third of intrahospital adverse events in some studies and are related to unreliable functioning of transport equipment and errant management of this equipment by clinicians involved in the transport. Another consideration is that patient transport may put anesthesia professionals and other clinicians at risk for physical harm due to ergonomic factors, transport stretchers or beds may weigh between 100 and 700 pounds. The bed width or length may invoke challenges with maneuvering the bed while also managing the airway or administering a medication. Anesthesia professionals report a high rate of work-related musculoskeletal disorders and injuries requiring the use of analgesics or they may need to take sick leave. Intra-hospital patient transport is a time when patient and clinician safety is at risk.
Speaker 2:Check out Table 1 in the article for a list of adverse events and risk factors associated with patient transport. These may be patient-specific, equipment-related or systematic. We are going to go through it now. First up, general adverse events, which includes complications related to staff, musculoskeletal injury and general patient instability. Risk factors in this category include age, male gender, obesity, patient condition, higher APACHE score, emergent transport, longer transport time, acidosis, elevated PaCO2, reduced pH and higher ASA status. Okay, quick commercial break to review the APACHE score. This stands for Acute Physiology and Chronic Health Evaluation score that is used in the ICU to assess illness severity and predict survival. The score depends on the patient's age, as well as certain vital signs and lab values such as mean arterial blood pressure, ph and potassium level. Okay, back to the main program.
Speaker 2:The second category is system and potential complications in this category include loss of information, transport to the wrong location, failure to respond to crisis, improper management of devices and care delay. Risk factors in this category include less experienced transport team, a resident directing transport rather than the attending physician, and lack of checklists. The next category is airway and respiratory. Hypoventilation, pneumothorax, hypoxemia and accidental extubation or displacement of the endotracheal tube are complications that may occur. Risk factors for these complications include mechanical ventilation, manual ventilation and the need for PEEP. The fourth category is cardiovascular Complications. In this category include hyper and hypotension arrhythmias, central line and arterial line displacement and cardiac arrest. Risk factors for cardiovascular complications include the use of vasopressors or inotropic agents.
Speaker 2:Next up is the neurologic category. Neurologic complications involve agitation, increased intracranial pressure, reduction in Glasgow Coma Score, seizures, secondary brain injury and patient discomfort. Risk factors for these complications include higher levels of sedation and inadequate monitoring during transport. The final category is equipment, and there are a lot of complications related to equipment, including the following Non-functioning ventilator, battery depletion, oxygen depletion, fluid depletion, infusion pump failure, equipment disconnection and monitoring incompatibility or disconnection and monitoring incompatibility or disconnection. Risk factors for these complications include higher number of monitors, poor preparation, inexperienced transport team and inadequate monitor inspection prior to transport. As you can see, there are a lot of complications that may arise during intra-hospital transport and a lot of risk factors.
Speaker 2:Anesthesia professionals need to remain vigilant to help keep patients safe during transport. Patients with higher severity of illness scores, older age and the need for pharmacologic support, especially sedative and vasopressor medications, mechanical ventilation, especially with PEEP, greater than six millimeters of mercury, obesity and reduced arterial oxygen saturation before transport are important patient-related factors that are associated with higher rates of complications during transport. The literature supports that critically ill patients in particular are at increased risk for inter-hospital transfer. Adverse events. If we look a little closer at the system or situational risk factors for adverse events, there is an increased risk for adverse events associated with longer duration transport with greater than 60 minutes spent outside the intensive care unit, poor handoff communication, urgent or emergent transport, staffing shortages and the use of less experienced healthcare or transport staff. Have you ever transported a patient through a cluttered hallway or been so focused on trying to drive the bed that it limited your ability to identify threats to patient safety during transport? These last two considerations have not been identified in the literature but often come up in discussion with anesthesia professionals about the challenges of inter-hospital transport professionals.
Speaker 2:About the challenges of inter-hospital transport. This week we talked about the significant challenges when it occurs to safely transporting patients in the hospital, especially critically ill patients. The good news is that the American College of Critical Care Medicine and the Society of Critical Care Medicine have developed guidelines for intra-hospital transport of critically ill patients to and from the ICU. This is an important step for improving perioperative patient safety during transport. We are going to review these guidelines and more on the show next week, so mark your calendars. If you have any questions or comments from today's show, please email us at podcast at APSForg. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSForg for detailed information and check out the show notes for links to all the topics we discussed today.
Speaker 2:The APSF newsletter is the official journal of the Anesthesia Patient Safety Foundation. Readers include anesthesia professionals, perioperative providers, key industry representatives and risk managers. It is free of charge and available in a digital format with a focus on anesthesia-related perioperative patient safety issues. The June newsletter has just been published, but the deadline for the October 2025 APSF newsletter is right around the corner, on July 1st. Check out the guide for authors over at apsforg for more information, and I will include a link in the show notes as well. Who knows, you could be the next APSF newsletter author and we might be featuring your article on a future anesthesia patient safety podcast. So what are you waiting for? Go ahead and submit your article today. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.