608

Abstract

Introduction: Transfer of patients from quaternary centers will increase in frequency as care becomes increasingly regionalized and resources concentrated. These patients can convalesce in their home institutions' ICU. We performed a literature review on Interhospital transport from ICU to ICU of critically ill patients. However, the majority of literature addresses intrahospital transports for procedures. Also, it describes only incidence of adverse events and risk factors for complication. There is paucity of data on policies to assure safe interhospital ICU transport. A transport policy coordinated with a multidisciplinary transport team (MTT) is indicated. Methods: A PubMed search was performed and keywords included "interhospital transport", "critically ill patients", "ICU transfers", and "transport policy". All information and recommendations were considered and our own institution's process was evaluated before establishing a policy. Results: Adverse events have been reported to occur from 30-70% of transports. These include changes in vital signs, respiratory status, increased vasopressor need, oxygen support and interventions. At our institution we created a policy to guide future interhospital transport. Elements include: 1) primary service determines ICU patient medically safe for transfer 2) physician will request Transport Team Meeting be arranged. Team includes the primary physician, members of nursing staff: Clinical Nurse Specialist (CNS) and most recent nurses caring for patient, social worker/discharge planner, transport/flight team manager and transport respiratory therapist 3) transport elements to be determined include level of care, mode of transport required to meet patient's medical needs, equipment resources and personnel expertise set needed. Also included is summary of patient's hospitalization 4) recommendations for these needs determined at the MTT meeting will be placed in the EMR, using a newly created template document which can be readily accessed for review 5) a referral will be submitted to our hospital transfer and communication center who will use this information to secure a transport provider who has all of these resources. Conclusions: Transparent policies can be created across all institutional ICUs for safe transport of critically ill patients. As a result of this literature review we found that there is data expressing the need for these policies but the policies themselves scarcely exist. To our knowledge this is the first description of an institutional policy for inter-hospital ICU to ICU transport of patents.