Effect of Interhospital ICU Relocation on Patient Physiology and Clinical Outcomes

Abstract

Relocation of large numbers of critically ill patients between hospitals is sometimes necessary and the risks associated with relocation may be high. In the setting of adherence to an interhospital intensive care unit (ICU) relocation protocol, we aimed to determine whether the interhospital relocation of all ICU patients in a single day is associated with changes in vital signs, device removal, and worse clinical outcomes. We conducted a prospective, observational, cohort study of all critically ill adults admitted to a tertiary medical center’s ICUs on the day of a planned hospital relocation and exposed to interhospital ICU relocation compared with unexposed critically ill adults. Changes in vital signs were evaluated by the before-and-after interhospital relocation measurement of vital signs, and clinical outcomes were collected for all patients. A total of 699 patients were admitted to the ICU during the observation period, 24 of whom were exposed to interhospital ICU relocation on a single day. The median interhospital transport duration was 28 minutes (interquartile range: 24-35) and 29% of patients were receiving invasive mechanical ventilation. Patients exposed to interhospital ICU relocation had no significant change in any vital sign measurement and no devices were unintentionally removed. Inhospital mortality was similar (8.3%) to patients not exposed to interhospital ICU relocation (9.2%, P > .99). In the setting of adherence to an ICU relocation protocol, the interhospital ICU relocation of all critically ill adults during a single day is not associated with changes in vital signs, device removal, or worse clinical outcomes.

Keywords

ICU organization ICU staffing interhospital transfer

Get full access to this article

View all access options for this article.

References

Halpern

Pastores

. Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38(1):65–71.

Halpern

. Innovative designs for the smart ICU: part 1: from initial thoughts to occupancy. Chest. 2014;145(2):399–403.

King

Dorfman

Einav

Niven

Kissoon

Grissom

. Evacuation of intensive care units during disaster: learning from the hurricane sandy experience. Disaster Med Public Health Prep. 2016;10(1):20–27.

deBoisblanc

. Black Hawk, please come down: reflections on a hospital’s struggle to survive in the wake of Hurricane Katrina. Am J Respir Crit Care Med. 2005;172(10):1239–1240.

Smith

Fleming

Cernaianu

. Mishaps during transport from the intensive care unit. Crit Care Med. 1990;18(3):278–281.

Braman

Dunn

Amico

Millman

. Complications of intrahospital transport in critically ill patients. Ann Intern Med. 1987;107(4):469–473.

Bellingan

Olivier

Batson

Webb

. Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients. Intensive Care Med. 2000;26(6):740–744.

Schwebel

Clec’h

Magne

, et al. Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study. Crit Care Med. 2013;41(8):1919–1928.

King

Niven

Beninati

, et al. Evacuation of the ICU: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146(suppl 4):e44S–e60S.

10.

Warren

Fromm

Orr

Rotello

Horst

; American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256–262.

11.

Faine

Noack

Wong

, et al. Interhospital transfer delays appropriate treatment for patients with severe sepsis and septic shock: a retrospective cohort study. Crit Care Med. 2015;43(12):2589–2596.

12.

van Lieshout

Binnekade

Reussien

, et al. Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial. Intensive Care Med. 2016;42(7):1146–1154.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.14 MB