Anesthesia Patient Safety Podcast

#259 Every Move Matters: Why Transport Safety Can Save Your Critical Patients

• Anesthesia Patient Safety Foundation • Episode 259

Share episode

Intrahospital transport of critically ill patients presents significant safety risks that can be mitigated through proper guidelines, checklists, and handoffs between care teams. The episode examines transport-related adverse events and complications while providing practical tools to enhance patient safety during these vulnerable transitions.

• Multiple categories of intrahospital transport adverse events including respiratory, cardiovascular, neurological and equipment-related complications
• Risk factors for transport complications including patient characteristics, transport circumstances, and team experience
• Society of Critical Care Medicine guidelines focusing on four components: communication, personnel, equipment and monitoring
• Comprehensive perioperative transport checklist covering identification, airway, breathing, circulation, neurological status and equipment
• Multi-Center Handoff Collaborative tools providing structured approaches to handoffs between care teams
• Recommendations including pre-transport risk assessment, education for all team members, and implementation of standardized checklists
• Importance of system design considerations like uncluttered hallways and team formations that optimize patient observation

The deadline for the October 2025 APSF newsletter is July 1st. Check out the guide for authors at APSF.org for more information.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/259-every-move-matters-why-transport-safety-can-save-your-critical-patients/

© 2025, The Anesthesia Patient Safety Foundation

Speaker 1:

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. Have you been involved in an intra-hospital transport of a critically ill patient recently? Last week, we talked about intra-hospital transport, adverse events and the many risk factors and complications. Did you notice any of these threats to patient safety during your transport? This week, we are excited to discuss important considerations for keeping patients safe during transport, including guidelines and checklists. Before we dive further into the episode, we'd like to recognize BD, a major corporate supporter of APSF. Bd has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, bd. We wouldn't be able to do all that we do without you. D. We wouldn't be able to do all that we do without you. We are returning to the February 2025 APSF newsletter. Today. Our featured article is once again 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. Then click on newsletter archives and scroll down until you get to February 2025. And then scroll down until you get to our featured article today and I will include the link in the show notes as well.

Speaker 2:

Intra-hospital transport adverse 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 monitor, ventilator or infusion pump malfunction, accidental dislodgement of lines, tubes and catheters, of lines, tubes and catheters or empty oxygen cylinders. Last week we reviewed table one in the article for a list of adverse events, complications and related risk factors. We are going to do a quick review now. Risk factors for patient instability during transport include age, male gender, obesity, patient condition, high Apache score, emergent transport, longer duration transport acidosis, elevated PaCO2, reduced pH and higher ASA status. When there is a less experienced transport team or a lack of checklists, there is a risk for failure to respond to a crisis, improper management of devices, care delay, transport to the wrong location or loss of information. There is an increased risk for airway and respiratory complications when patients require mechanical or manual ventilation or PEEP during transport. Risk factors for hemodynamic instability, arrhythmias, central line displacement and cardiac arrest during transport include the use of vasopressors or inotropic agents, patients who require higher levels of sedation or who do not have adequate monitoring during transport are at risk for neurologic complications ranging from agitation to seizures and increased intracranial pressure. Finally, equipment malfunction, disconnection or failure during transport is more likely when there are more monitors used during transport, poor preparation for transport, an inexperienced transport team and inadequate pre-inspection of monitors and devices. Anesthesia professionals need to remain vigilant to help keep patients safe during transport, and we have some guidelines to talk about and checklists to review, so let's return to where we left off in the article.

Speaker 2:

The Society of Critical Care Medicine has published guidelines for intra-hospital transport of critically ill patients with a focus on four critical components of transport communication, personnel, equipment and monitoring. The communication component for safe transport involves clinician-to-clinician handoff, when the receiving location assumes management of the patient and shares information to other involved disciplines regarding the timing of transport and equipment required. This may involve a conversation about respiratory care for the patient with the current ventilator settings or the level of sedation and infusions, or the timing for the next dose of antibiotics. The guidelines recommend a minimum of two people for the transport of a critically ill patient. This falls in the personnel component of the guidelines. Another important consideration is the experience and skills of the transport clinician, who will need to have experience with airway management and advanced cardiac life support for intubation and critically ill patients. The transport team will also need to be familiar with the equipment required for transport and be able to navigate between the two locations in the hospital.

Speaker 2:

An important principle when it comes to monitoring patients during transport is that the level of monitoring should not be reduced during transport. Minimum monitoring requirements for critically ill patients must include blood pressure, pulse oximetry and EKG Under the equipment component. It is important to make sure that all necessary equipment is fully charged and capable of functioning for the entirety of the transport duration. Make sure that you have all medications that you might need for resuscitation during transport ready to go and clearly labeled. There are additional guidelines from the American Society of Anesthesiologists regarding the transport of patients from the operating room to the post-anesthesia care unit. No-transcript. Anesthesia professionals are important ingredients in the safe intra-hospital transport recipe. Following anesthesia care During transport, it is important for anesthesia professionals to consistently assess the patient's condition and be prepared to treat and monitor depending on their clinical judgment. Important steps to keep patients safe include regular patient and equipment checks, meticulous patient preparation, correct use of protocols and transport locations that are within easy reach.

Speaker 2:

Intra-hospital transport of critically ill patients represent an excellent opportunity to use standardized transport checklists. Are you using these at your institution? Let's take a look at Table 2 in the article for a perioperative intra-hospital patient transport checklist. There are several systems in the list and each system has a couple critical points to address. The first system is identification and information. This includes ID band on the patient chart with patient necessary consents present and confirm the ICU, pacu or operating room is prepared for the patient. Next we have the airway considerations, including endotracheal tube secured airway precautions necessary manual bag valve mask present and emergency airway management equipment available. Breathing is the next system, with the following points Mode of delivery of oxygen, confirmed oxygen supply, adequate transport, ventilator charged and functioning and patient on ventilator For circulation.

Speaker 2:

It's important to check the following critical points IV lines identified for resuscitation, emergency medications necessary and available infusion pumps and monitor. Adequately charged hemodynamic alarm set and defibrillator necessary and present. The next category is neurologic. It is important to address the following points Sedation pain control. Adequate spinal precautions necessary and patient stable and safe for movement. Some additional critical points and precautions include personal protective equipment present lines, tubes, drains secured and rails raised and the final steps are connect the monitors, plug in bed, perform comprehensive handoff.

Speaker 2:

We made it through the checklist and, as you can see, there is nothing in that list that you want to miss in preparation for an intra-hospital transport of a critically ill patient. Also, we need to return to the final step in the checklist. It was perform a comprehensive handoff. That may seem a little daunting after going through the entire checklist process, but the good news is that we have additional resources for this. Have you heard of the Multi-Center Handoff Collaborative? This initiative is all about perioperative patient handoffs Getting it right. The collaborative was formed in 2015 and is supported by the APSF as a special interest group to address one of its 2018 patient safety priorities patient-related communication issues, handoffs and transitions in care. For more information, head over to APSForg and click on the patient safety resources heading.

Speaker 2:

The fifth one up from the bottom is collaborations, and then select the multi-center handoff collaborative. From here you can check out the handoff education database. Their tools include general handoff tools, icu to OR resources, interoperative resources, or to ICU resources, or to PACU resources and other resources. Let's take a closer look at the ICU to OR resources. Here you will find a pocket card with all the details you need for a safe and effective handover from the ICU to the OR team prior to transport. Don't worry, I will put the link in the show notes as well. The pocket card involves a three-step process. Step one involves the ICU clinician asking is everyone here? If yes, then state hand over time. In this is. Insert patient name here who is to undergo a procedure, state the surgery or procedure and the surgeon's name the patient is a. Insert the age of the patient here who has a primary diagnosis of. Fill in the blank here and is in our ICU for and insert the reason for the current admission here for and insert the reason for the current admission here.

Speaker 2:

Now we move on to step two, where the ICU physician and the bedside ICU nurse complete their checklists. The ICU physician is responsible for addressing the following the patient ID and armband check, pertinent history, end organ dysfunction, abnormal labs. And then what are they most worried about? And finally, does anyone have any questions? The bedside ICU nurse must address the NPO status, height and weight, dosing and actual allergies, infusions, access, airway meds due drains and tubes and any family concerns and the location of the family. The operating nurse should confirm the OR consents and then should address the post-operative plan and ask any further questions. The final step is the ICU clinician saying Does anyone have any questions? Is everyone on the same page? Tag you are now the care team. Is this what your handoff looks like in the ICU before bringing a patient to the operating theater? The Handoff Education Database is an excellent resource to streamline the handoff process and improve patient safety, teamwork and communication. We hope that you will check it out. Now let's return to the APS article for the conclusion. Now let's return to the APS article for the conclusion.

Speaker 2:

The authors advocate for the perioperative transport of seriously ill patients under the careful guidance of the anesthesia care team. There are increasing challenges to patient safety, from patient acuity to production pressure to care volume, and anesthesia professionals must be proactive to increase patient safety during transport while maintaining clinician well-being. Here are several recommendations to achieve these goals. Number one patient assessment before transport should include the identification of risk factors associated with inter-hospital transport adverse events. Number two all anesthesia team members, as well as others involved in patient movement, should be educated on the potential harm of inter-hospital transport and on proven practices that minimize these harms. This involves education about current guidelines and the use of checklists and handoff tools.

Speaker 2:

Number three the use of perioperative patient transport checklists may be beneficial to assure that patients are prepared, equipment is functioning with backup power supply, records are present and communication has occurred. You can use Table 2 from the article and communication has occurred. You can use Table 2 from the article. Such checklists should be used at initiation of transport, during handoff at the receiving location and upon return to the original location. Number four anesthesia professionals should participate in system design when patient transport is involved.

Speaker 2:

Factors to consider are uncluttered hallways, easily maneuverable beds and stretchers, and team formation that allows the anesthesia professional to observe the patient and intervene without distraction, while other team members assume primary responsibility for patient physical bed movement. And number five perioperative transport by anesthesia professionals should be promoted as an important focus of academic study. Can you work on any of these recommendations at your institution? We hope that you can address some of these considerations to help improve patient safety during inter-hospital transport wherever you practice anesthesia care, and we hope that you will share the resources that we talked about today the checklist and handoff tool with your colleagues and anyone who is involved in inter-hospital patient transport at your institution. 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. 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.