Real emotional experience of family members of patients transported within hospital in neurosurgical intensive care unit: A descriptive qualitative study.

AIM: To understand the real experience of family members of patients in neurosurgical intensive care unit (NICU) during intra-hospital transport (IHT), explore their inner needs and provide effective intervention measures for the construction of standardized IHT plan. DESIGN: A descriptive qualitative study. METHODS: For the purposes of this study, 10 family members of IHT patients were included using a purposive sampling method. Semi-structured in-depth interviews were used to collect the data, Nvivo 11 software was used to organize the data, and Colaizzi's 7-step descriptive phenomenology method was used to analyse the data. RESULTS: A total of three themes and nine subthemes were extracted, namely: Experience of emotional changes at different stages (uncertainty before transfer, complex internal activity during transit, ambivalence after transfer); Perception of problems in IHT (poor doctor-patient communication, weak awareness of risk assessment, deficiencies in the transfer procedure); Consciousness of the real needs (emotional respect and closeness, stay informed of the progression of the disease, greater social support). CONCLUSION: Family members of patients in the NICU have complex internal experiences and multiple support needs during IHT, reflecting the need for further standardization of the transport process. In the future, we should improve the mode of safe IHT involving doctors, nurses and family members of patients, ensure the safety of patient transport, meet the social support needs of family members and improve the experience of IHT and the medical satisfaction of family members.

Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study.

An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate; n = 103, 42% HIC and n = 143, 58% LMIC) participated. LMIC hospitals were less likely to report a portable CT scanner (RR 0.39, 95% CI [0.23; 0.67]), more likely to report a pre-IHT checklist (RR 2.18, 95% CI [1.53; 3.11]), and more likely to report that intensive care unit (ICU) physicians routinely participated in IHTs (RR 1.33, 95% CI [1.02; 1.72]). Between- and across-country variation were highest for pre-IHT external ventricular drain clamp tolerance (reported by 40% of the hospitals, ICC 0.22, 95% CI 0.00-0.46) and end-tidal carbon dioxide monitoring during IHT (reported by 29% of the hospitals, ICC 0.46, 95% CI 0.07-0.71). Brain tissue oxygenation monitoring during IHT was reported by only 9% of the participating hospitals. An IHT standard operating procedure (SOP)/hospital policy (HP) was reported by 37% (n = 90); HIC: 43% (n= 44) vs. LMIC: 32% (n = 46), p = 0.56. Amongst the IHT SOP/HPs reviewed (n = 13), 90% did not address the continuation of hemodynamic and neurophysiological monitoring during IHT. In conclusion, the development of a neurocritical-care-specific IHT SOP/HP as well as the alignment of practices related to the IHT of neurocritically ill patients are urgent unmet needs. Inconsistent standards related to neurophysiological monitoring during IHT warrant in-depth scrutiny across hospitals and suggest a need for international guidelines for neurocritical care IHT.

Improving the safety and quality of the intra-hospital transport of critically ill patients.

BACKGROUND: Adverse events during patient transport are common and may threaten critically ill patients' lives. AIM: This study aimed to determine the incidence of adverse events during intra-hospital transport and to obtain suggestions from critical care nurses for improving the transportation process. DESIGN: This was a cross-sectional study. METHODS: This study was carried out with 160 critical care nurses between September 2018 and January 2019. Data were collected through a semi-structured interview using a 53-item questionnaire developed by Brunsveld-Reinders et al. It assesses nurses' experiences of adverse events during the three phases of intra-hospital transport related to equipment, patient physiology, monitoring, medications, and fluid management. The data were analysed using descriptive statistics in SPSS software, and the responses of open-ended questions were analysed using a conventional qualitative content analysis. RESULTS: On scales from 0 to 10, the mean (and SD) values of fear, confidence, and skill to carry out a safe intra-hospital transport were 2.66 (2.73), 6.45 (3.16), and 7.75 (1.55), respectively. The most important causes of feeling afraid or unconfident about the transport among the nurses were unstable patient condition, cardiac arrest, extubation, and oxygen desaturation. In all three phases, oxygen desaturation, haemodynamic instability, and agitation were reported as the most frequent events. The most important suggestions by nurses for improving the transport process were related to paying attention to the patient's clinical condition and connections before, during, and after the transfer. CONCLUSIONS: Along with the acquisition and improvement of technical and tactical skills, adequate human resources and appropriate equipment can improve the quality of intra-hospital transport. RELEVANCE TO CLINICAL PRACTICE: Nurses are key members of the transport team and lead the team. They are responsible for keeping patients safe during transport. By identifying adverse events and trying to modify risk factors, nurses can improve patients' safety.

Bedside laparotomy in newborns -A single institute experience.

BACKGROUND/PURPOSE: Intra hospital transfer of sick newborns is known to cause adverse events with potential morbidity. Interventions at the bedside in a sick neonate can reduce the need for transport and in turn, potential hazards of transfer. Our single institute experience of performing bedside laparotomies in unstable newborns is reported here. MATERIALS AND METHODS: Seven-year data was collected from electronic medical records. This was a retrospective comparative study with level III evidence. Twenty-eight neonates operated at bedside for intraabdominal sepsis due to Necrotising Enterocolitis (NEC), Spontaneous Intestinal Perforation (SIP), complicated meconium ileus and perforation secondary to atresias were included Group A. Group B had 60 neonates operated for similar indications in the conventional operation theatres. RESULTS: The average corrected gestational age at surgery, associated co-morbidities, average volume of blood loss and duration of surgery were compared between the groups. Group A had lower weight at surgery (1098 vs 1872 gs), greater percentage of neonates on inotropic support (78% vs 20%) with requirement of High Frequency Ventilation (HFO) (50% vs none). A quarter of neonates (7 of 28) in Group A had NEC Totalis as against only one case in group B. There was 25% survival in group A and 76.67% in group B. The lower survival in group A can be attributed to lower weight at surgery, higher inotrope requirement and need for unconventional modes of ventilation. CONCLUSION: Bedside laparotomy is a feasible option in unstable neonates deemed unsuitable for transport.

Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay.

BACKGROUND: The short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay. METHODS: The study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the "Inconforts des Patients de REAnimation" (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed. RESULTS: Patients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0-5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores. CONCLUSION: Patients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients' perceptions of their ICU stay regarding recalled pain. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015.

Effects of heated gel mattress for prevention of hypothermia in preterm infants during intra-hospital transport: a Meta-analysis and trial sequential analysis / 中国实用护理杂志

Objective To evaluate the efficacy and safety of heated gel mattress(HGM) for prevention of heat loss on preterm infants with hypothermia during the transport systematically and objectively. Methods Systematic searches on PubMed, EMBASE, Cochrane Library, Web of Science CBM,CNKI,Wanfang and VIP were performed for randomized controlled trials or quasi-randomized control trials which explored the effects of HGM on prevention of hypothermia in premature infants relative to conventional alternatives. Studies were screened according to inclusion and exclusion criteria,extracting data and assessing quality. Then, Meta-analysis and trial sequential analysis were performed by using RevMan 5.3 and TSA v0.9 software developed at the Copenhagen Clinical Trials Center in Denmark, independently. Results This systematic review included 10 studies which comprised 7 randomized controlled trials and 3 quasi-randomized control trials, encompassing 773 patients. The results of Meta-analysis showed that in HGM group admission temperature on neonatal intensive care unit (standardized mean difference was 0.63, 95% confidence interval was 0.40-0.87, P=0.00), incidence of hypothermia (relative risk was 0.73, 95% confidence interval was 0.57-0.93, P=0.01) and hyperthermia (relative risk was 1.82, 95% confidence interval was 1.31-2.54, P=0.00) compared with the control group had significantly statistical difference;however, there was no significant difference in admission temperature on EM or TWM group, mortality, sepsis, retinopathy of prematurity, intraventricular hemorrhage III/IV between two groups. TSA confirmed that the pooled results of admission temperature on NICU and hyperthermia were stable and reliable; but the combination of low-temperature incidence and mortality indicators suggested that the sample size was insufficient. Conclusions HGM is an effective rewarming intervention that can improve body temperature of hypothermic preterm infants during transport, reduce the incidence of hypothermia but not decrease the incidence of morbidity and complications. However, it is recommended that clinical monitoring of body temperature should be performed dynamically to decrease the potential risk of high fever and complications. In addition, due to the limitation of quantity and quality of included studies, its cost-effectiveness and far-reaching influence on long-term follow-up outcomes need further evaluation through clinical multicenter, large sample, high-quality research.

Multiple intra-hospital transports during relocation to a new critical care unit.

OBJECTIVE: Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We outline the process and adverse events associated with the relocation of a critical care unit. DESIGN: Extensive planning of the relocation targeted patient and equipment transfer, reduction in clinical pressure prior to the event and patient care during the relocation phase. SETTING: The setting was a 30-bed, tertiary referral, combined medical and surgical critical care unit, located in a 570-bed hospital that serves as the national referral centre for cardiothoracic surgery and spinal injuries. PARTICIPANTS: All stakeholders relevant to the critical care unit relocation were involved, including nursing and medical staff, porters, information technology services, laboratory staff, project development managers, pharmacy staff and building contractors. MAIN OUTCOME MEASURES: Mortality at discharge from critical care unit and discharge from hospital were the main outcome measures. A wide range of adverse events were prospectively recorded, as were transfer times. RESULTS: Twenty-one patients underwent IHT, with a median transfer time of 10 min. Two transfers were complicated by equipment failure and three patients experienced an episode of hypotension requiring intervention. There were no cases of central venous or arterial catheter or endotracheal tube dislodgement, and hospital mortality at 30 days was 14%. CONCLUSION: Although IHT is associated with morbidity and mortality, careful logistical planning allows for efficient transfer with low complication rates.

Intra-hospital transport nursing of patients with severe inhalation pulmonary injury treated with extracorporeal membrane oxygenation / 现代临床护理

Objective To explore the nursing experience of the safe intra-hospital transport of patients with the severe aspiration of the inhalation injury. Method The nursing measures for the intra-hospital transport of 2 cases of smoke pot inhalation injury caused by extracorporeal membrane oxygenation treatment were taken, including disease risk assessment, preparation for transport, organization of a transport team, effective vital signs monitoring during transport, extracorporeal membrane oxygenation (ECMO) pipeline monitoring and nursing and observation and nursing of complications. Result No emergency was found during the transport of patients and both of them were safely transported. Conclusion Such nursing measures as pre-transport assessment and preparation and bettering predictive nursing for the patients with severe inhalation pulmonary injury treated with extracorporeal membrane oxygenation are key to the safety during intra-hospital transport.

Application of standardized workflow in intra-hospital transport of human infections of avian influenza A(H7N9)virus / 中国实用护理杂志

Objective To summarize the successful application experience of intra-hospital transport of 13 H7N9 avian influenza patients from the general wards to the avian influenza ward. Methods Form the expert group, to determine the design target and principle of the standardized workflow and point out the operation points of standard workflow in intra-hospital transport of each link. Results The standardized workflow included the disposal of the transfer notice, condition assessment, department contact,patient preparation,object preparation,custody transfer personnel preparation,transit guardianship and transfer to the avian influenza ward,a total of eight procedures.Between January 2013 and March 2017,13 cases were successfully transfered.All patients safely arrived avian influenza ward. The process was quick and smooth.Nobody was died or rescued within 1 h after transport. Conclusions The main differences of intra-hospital transport between H7N9 avian influenza patients and general critically ill patients are the transit time control, the particularity of terminal disposal, transshipment arrangement and hospital infection management personnel involved in the whole process.

Risk factors of oxygen saturation decrease during intrahospital transportation of intensive care unit patients in emergency department / 中华护理杂志

Objective To explore risk factors of oxygen saturation (SpO2) decrease during intrahospital transporta-tion (IHT) of intensive care unit (ICU) patients in emergency department,and provide theoretical basis for prevent-ing oxygen saturation decrease during intrahospital transportation. Methods A cross-sectional study design was adopted,from April to May,2017,we investigated 182 ICU patients who required IHT in an emergency department in a tertiary hospital in Shanxi Province by using self-designed Evaluation Form of Intrahospital Transportation for ICU Patients in Emergency Room. We divided patients into two groups based on whether their SpO2 decreased or not. Risk factors of SpO2 decrease were identified by univariate and multivariate Logistic regression analysis. Results Among 182 patients,117 had SpO2 decrease,and the rate of SpO2 decrease was 64.3%. Patient's age,MEWS score, disease type,escort personnel,and oxygen supply device were risk factors of SpO2 decrease. Conclusion SpO2 de-crease is the result of combination of multiple risk factors during IHT. We ought to enhance training of escort person-nel,assess patient's condition and SpO2 level accurately and make plan before transportation,choose qualified oxygen supply device to ensure patients can have effective oxygen supply during IHT,which prevent SpO2 decrease during IHT.

An evaluation of intra-hospital transport outcomes from tertiary neonatal intensive care unit.

INTRODUCTION: Patient transport has more important side effects in patients in the newborn age group than in other age groups. This study was performed to evaluate the intra-hospital transport of infants in the neonatal intensive care unit(NICU). METHODS: A total of 284 babies hospitalized in the neonatal unit and transported inside the hospital were divided into three groups based on their weights at the time of transport. Their places of transport and important changes in the vital functions of the newborn that might have been caused by transport were recorded with a view to understand the vital effects of intra-hospital transport on the newborn. RESULTS: In our unit, the primary reasons for transport were determined to be echocardiography and radiology (26.4% and 25.7%, respectively). In our study, hyperglycemia and hypothermia were among the statistically most significant side effects associated with transport (p < 0.05). It was found that 19% and 27% of the patients had hyperglycemia and hypothermia, respectively. There was a significant difference in the blood sugar levels and the body temperature between pre- and post-transport (p < 0.05). There were no significant differences in the pH, blood gas CO2, heart rate and breath rate values between pre- and post-transport (p > 0.05). As expected, the complication rate was higher in babies with low weight. CONCLUSIONS: Current weight is useful for assessing the risks of untoward outcomes associated with intra-hospital transport. Protecting patients from hypothermia during the time spent outside of the NICU would reduce the risk of complications.

Unexpected events occurring during the intra-hospital transport of critically ill ICU patients.

BACKGROUND: Intra-hospital transport of critically ill patients is a challenging task. However, despite the improvements in intra-hospital transport practices, adverse event incidents remain high and constitute a significant risk for the transport of the critically ill ICU patients. OBJECTIVES: To observe the number and types of unexpected-events (UEs) occurring during intra-hospital transport of critically ill ICU patients. Interventions provided along with outcome. MATERIALS AND METHODS: This was a prospective observational study of 254 intra-hospital critically-ill ICU patients of our hospital transported for diagnostic purposes during April 2012 - March 2013. The escorting intensivist completed the data of unexpected events during transport. RESULTS: A total of 254 patients were observed prospectively for UEs during intra-hospital transfer of critically ill patients. The overall UEs observed were 139 among 64 patients. Among the UEs which occurred, the maximum were miscellaneous causes [89 (64.00%)] like oxygen probe [38 (27.33%)] or ECG lead displacement [27 (19.42%)]. Major events like fall in spo2 >5% observed in 15 (10.79%) patients, BP variation > 20% from baseline in 22 (15.82%) patients, altered mental status in 5 (3.59%), and arrhythmias in 6 (4.31%) patients. Among 64 (100%) patients with UEs, 3 (2.15%) patients with serious adverse events have been aborted from transport. CONCLUSION: Unexpected-events (UEs) are common during transport of critically ill ICU patients and these adverse events can be reduced when critically ill patients are accompanied by intensivist/medically qualified person during transport and following strict transport guidelines.

Application of transport procedure on intra-hospital transport of critically ill patients / 现代临床护理

Objective To explore the effect of transport procedure adopted on intra-hospital transport of critically ill patients. Methods Three hundred and fifteen critically ill patients(control group)were intra-hospital transported adopting traditional method,while 309 ones(experimental group)adopting transport procedure. The occurrence rate of accidents of both groups and satisfactory rate of nurses in which the patients were admitted.Result The occurrence rate of accidents in experiment group was lower than that in control group and the satisfactory rate of nurses on transport procedure was higher than that on traditional method with statistical difference(P<0.01).Conclusion The application of transport procedure can effectively minimize the risk of critically ill patients during intra-hospital transport and increase satisfactory rate of medical staffs.