Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team

Abstract

IntroductionIn order to minimize the additional risk of interhospital transport of critically ill patients, we started a mobile intensive care unit (MICU) with a specialized retrieval team, reaching out from our university hospital-based intensive care unit to our adherence region in March 2009. To evaluate the effects of this implementation, we performed a prospective audit comparing adverse events and patient stability during MICU transfers with our previous data on transfers performed by standard ambulance.MethodsAll transfers performed by MICU from March 2009 until December 2009 were included. Data on 14 vital variables were collected at the moment of departure, arrival and 24 hours after admission. Variables before and after transfer were compared using the paired-sample T-test. Major deterioration was expressed as a variable beyond a predefined critical threshold and was analyzed using the McNemar test and the Wilcoxon Signed Ranks test. Results were compared to the data of our previous prospective study on interhospital transfer performed by ambulance.ResultsA total of 74 interhospital transfers of ICU patients over a 10-month period were evaluated. An increase of total number of variables beyond critical threshold at arrival, indicating a worsening of condition, was found in 38 percent of patients. Thirty-two percent exhibited a decrease of one or more variables beyond critical threshold and 30% showed no difference. There was no correlation between patient status at arrival and the duration of transfer or severity of disease. ICU mortality was 28%. Systolic blood pressure, glucose and haemoglobin were significantly different at arrival compared to departure, although significant values for major deterioration were never reached. Compared to standard ambulance transfers of ICU patients, there were less adverse events: 12.5% vs. 34%, which in the current study were merely caused by technical (and not medical) problems. Although mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was significantly higher, patients transferred by MICU showed less deterioration in pulmonary parameters during transfer than patients transferred by standard ambulance.ConclusionsTransfer by MICU imposes less risk to critically ill patients compared to transfer performed by standard ambulance and has, therefore, resulted in an improved quality of interhospital transport of ICU patients in the north-eastern part of the Netherlands.

Inter-hospital transport of critically ill patients: the reality of a hospital in the Northeast region of Portugal

“…In a literature review, Droogh et al (2015) concluded that the number of transfers is likely to increase with the centralization of specialized care. Wiegersma et al (2011) found that specialist consultations or advanced/specialized therapy were the main indications for transfer, which is in line with the results found in this study, where 38% of patients were transferred to be examined by specialist and 37% to perform specialized therapeutic interventions. The SUMC of ULSNE -Hospital Unit of Bragança integrates the second level of care and is located in the north region of the country; hence, patients who cannot be treated there must be transferred.…”

“…The most common diagnosis was neurological disease, followed by cardiovascular disease. In an observational study conducted by Wiegersma et al (2011) in the northeast region of the Netherlands on patient transfers to more differentiated hospitals, the main diagnosis of transfer was respiratory failure (27%), followed by sep-sis (17.6%), and multi-organ failure (10.8%). These results are contrary to those found in this study, where respiratory diseases appear in fifth place.…”

Interhospital critical care transports: have a safe trip!

“…However, in the study of van Lieshout et al adverse events occurred in 15-16 % of transports in both groups [1]. In another study we found that the percentage of adverse events during transports performed with a dedicated MICU team was 12.5 % [2], and in a successive study most adverse events appeared to be caused by failure of technical equipment [3]. It would appear, therefore, that adverse events can be patient-or equipment-related, or both, and may differ in seriousness.…”

A system of delivering medical staff members by helicopter to manage severely wounded patients in an area where medical resources are limited

“…This is because the transfer by a mobile intensive care unit staffed by trained physicians imposes less risk to critically ill patients than a transfer by standard ambulance 4. In addition, the benefits of DH include the highest level of prehospital medical care and transportation 5.…”