The risk of intrahospital transport to patients

Abstract

I read with interest the article “Keeping Patients Safe During Intra-hospital Transport” (August 2010: 18–32) and I appreciated the extensive literature review carried out by the author. I have some concerns about the absence in the article of mortality data related to in-hospital transportation. Beckmann et al1 analyzed data from the Australian Incident Monitoring Study in Intensive Care (AIMS-ICU) and found a mortality rate of 2% among 176 anonymous incident reports related to patients’ transportation. In my opinion, the number of deaths caused by in-hospital transfer is underestimated in the literature, and anecdotal events of this kind are widespread among critical care health care workers. Perhaps reliable information about this important issue should be collected by totally anonymous incident reporting systems such as the AIMS-ICU.Also, I would like to integrate the interesting review in this article with data from an old but important observational study about mishaps during 125 intrahospital transportations of critically ill patients, performed by Smith et al in 1990.2 These authors found that 75% of mishaps occurred during radiological tests and, in turn, 75% of these incidents occurred during computed tomography scans. So, we must pay lot of attention while performing radiological imaging tests, when the patients are “left alone” beyond the glass.Finally I agree with the author that further research about patient transport within the hospital is needed. Particular issues should be studied; for example, the risk of cross-infections from the use of transport equipment (ie, transport ventilator breathing circuits) and the development of a mobile intensive care unit3,4 for in-hospital transportation of instable patients with large complex life support devices such as extracorporeal membrane oxygenation and mechanical ventilators.