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Abstract

408 APACHE = Acute Physiology and Chronic Health Evaluation; APS = Acute Physiology Score; ARDS = acute respiratory distress syndrome; CT = computed tomograpy; ICU = intensive care unit. Critical Care December 2004 Vol 8 No 6 Stacey and VennThe risks associated with interhospital transfer are widely accepted; less is known about patient transfer within hospitals. Beckmann and coworkers [1] sought to redress this through a review of reports submitted to the Australian Incident Monitoring Study in Intensive Care (AIMS-ICU). Their results, although by their own admission lacking numerator or denominator values, and prone to both volunteer and selection bias, are perhaps unsurprising. Of the reports, 31% detailed serious adverse outcomes; 39% of these involved problems with equipment (principally failures of power supply to monitors and infusion pumps, and problems with intubation equipment) and with access to patient elevators. Of the patient/staff issues that comprised the remainder, poor communication was most commonly quoted. Other problems included malpositioning of the artificial airway, dislodgement of vascular access, inadequate monitoring and incorrect patient handling. Contributing factors were divided into system-based and human-based factors. Prime among the former were communication problems, inadequate protocol and equipment failure. Of the human-based factors, errors in judgement and problem recognition, failure to follow protocol, undue haste and inadequate patient preparation were common. Harm was limited with almost equal frequency by 'rechecking the patient' and 'rechecking equipment'. The most eye-opening statistic was that, in 82% of cases, detection of incidents was by nursing staff. Are nurses intrinsically more eagle-eyed, or are doctors merely better at brushing near misses under the carpet?Transfers may be further complicated by the presence of cervical collars and spinal precautions. Morris and coworkers [2] reminded us of the complications of prolonged spinal immobilization as they sought to derive an evidence-based protocol to facilitate the identification or exclusion of cervical spine injury. Principal among these is cutaneous pressure ulceration, occurring in up to 55% of patients [3]. Other complications include elevated intracranial pressure, difficulty in obtaining airway control and central venous access, poor mouth care, pulmonary aspiration, failed enteral nutrition, restricted physiotherapy and deep vein thrombosis. Of the current imaging modalities, plain cervical radiography combined with computed tomography (CT) has a similar sensitivity (> 99%) to magnetic resonance imaging and dynamic fluoroscopy in the detection of unstable cervical spine injury. The authors proposed removal of spinal immobilization and precautions if plain radiographs and directed high-resolution CT of the craniocervical junction and CommentaryRecently published papers: Clunk-click every trip, smile, but don't stop for a drink on the way AbstractReviews of the risks associated with intrahospital transfe...