Special ArticlesGuidelines for the inter- and intrahospital transport of critically illpatients*Jonathan Warren, MD, FCCM, FCCP; Robert E. Fromm Jr, MD, MPH, MS; Richard A. Orr, MD;Leo C. Rotello, MD, FCCM, FCCP, FACP; H. Mathilda Horst, MD, FCCM; American College of Critical CareMedicineTof the potential benefits of transportweighed against the potential risks. Crit-ically ill patients are transported to alter-nate locations to obtain additional care,whether technical, cognitive, or proce-dural, that is not available at the existinglocation. Provision of this additional caremay require patient transport to a diag-nostic department, operating room, orspecialized care unit within a hospital, orhe decision to transport a crit-ically ill patient, either withina hospital or to another facil-ity, is based on an assessmentit may require transfer to another hospi-tal. If a diagnostic test or procedural in-tervention under consideration is un-likely to alter the management oroutcome of that patient, then the needfor transport must be questioned. Whenfeasible and safe, diagnostic testing orsimple procedures in unstable or poten-tially unstable patients often can be per-formed at the bedside in the intensivecare unit (1, 2). Financial considerationsare not a factor when contemplatingmoving a critically ill patient.Critically ill patients are at increasedrisk of morbidity and mortality duringtransport (3–17). Risk can be minimizedand outcomes improved with carefulplanning, the use of appropriately quali-fied personnel, and selection and avail-ability of appropriate equipment (16–37).During transport, there is no hiatus inthe monitoring or maintenance of a pa-tient’s vital functions. Furthermore, theaccompanying personnel and equipmentare selected by training to provide for anyongoing or anticipated acute care needsof the patient.Ideally, all critical care transports, bothinter- and intrahospital, are performed byspecially trained individuals. Since therewill almost certainly be situations when aspecialized team is not available for inter-hospital transport, each referring and ter-tiary institution must develop contingencyplans using locally available resources forthose instances when the referring facilitycannot perform the transport. A compre-hensive and effective interhospital transferplan can be developed using a systematicapproach comprised of four critical ele-ments: a) A multidisciplinary team of phy-sicians, nurses, respiratory therapists, hos-pital administration, and the localemergency medical service is formed toplan and coordinate the process; b) theteam conducts a needs assessment of thefacility that focuses on patient demograph-ics, transfer volume, transfer patterns, andavailable resources (personnel, equipment,emergency medical service, communica-tion); c) with this data, a written standard-ized transfer plan is developed and imple-mented; and d) the transfer plan isevaluated and refined regularly using astandard quality improvement process.This document outlines the minimumrecommendations for transport of thecritically ill patient. Detailed guidelines*See also p. 305.From Northwest Community Hospital, ArlingtonHeights, IL (JW); Baylor College of Medicine, Houston, TX(REF);Children’sHospitalofPittsburgh,UniversityofPitts-burgh School of Medicine, Pittsburgh, PA (RAO); Subur-ban Hospital, Bethesda, MD (LCR); Henry Ford Hospital,Detroit, MI (HMH).These guidelines have been developed by the Amer-ican College of Critical Care Medicine and the Society ofCriticalCareMedicine.Theseguidelinesreflecttheofficialopinion of the Society of Critical Care Medicine and do notnecessarilyreflect,andshouldnotbeconstruedtoreflect,the views of certification bodies, regulatory agencies, orother medical review organizations.Copyright © 2004 by Lippincott Williams & WilkinsDOI: 10.1097/01.CCM.0000104917.39204.0AObjective: The development of practice guidelines for the con-duct of intra- and interhospital transport of the critically ill pa-tient.Data Source: Expert opinion and a search of Index Medicusfrom January 1986 through October 2001 provided the basis forthese guidelines. A task force of experts in the field of patienttransport provided personal experience and expert opinion.Study Selection and Data Extraction: Several prospective andclinical outcome studies were found. However, much of the pub-lished data comes from retrospective reviews and anecdotalreports. Experience and consensus opinion form the basis ofmuch of these guidelines.Results of Data Synthesis: Each hospital should have a for-malized plan for intra- and interhospital transport that addressesa) pretransport coordination and communication; b) transportpersonnel; c) transport equipment; d) monitoring during transport;and e) documentation. The transport plan should be developed bya multidisciplinary team and should be evaluated and refinedregularly using a standard quality improvement process.Conclusion: The transport of critically ill patients carries in-herent risks. These guidelines promote measures to ensure safepatient transport. Although both intra- and interhospital transportmust comply with regulations, we believe that patient safety isenhanced during transport by establishing an organized, efficientprocess supported by appropriate equipment and personnel. (CritCare Med 2004; 32:256–262)KEY WORDS: intrahospital transport; interhospital transport; crit-ical care; health planning; policy making; monitoring; standards256Crit Care Med 2004 Vol. 32, No. 1
