Interhospital transport of critically ill patients in Norway. Taking a chance on behalf of the patient

Abstract

The most severely ill patients, with failure in one or several organ systems and in need of critical care, are treated at the Intensive Care Unit. Sometimes these patients must be transferred to a higher level of intensive care for more specialised treatment and later transferred back to the referring hospital. These transports are performed daily throughout Norway, but there are no national standards for interhospital transport. To examine and describe these transports in Norway, we obtained a triangulated view through questionnaires, in-depth-interviews, registration of incidents, and examination of databases. These transports may drain the personnel resources at the local hospital. National guidelines regarding management of transport of critically ill patients were warranted. The participating personnel felt expected to participate despite sometimes limited education and competence, and there was a lack of guidelines. Of two-hundred and ninety-four self-reported adverse events, only three were registered in the hospital`s electronic incident reporting system. An expert group were inconsistent in the grading of severity of the incidents and in their assessment of which incidents should have been reported. The review of all consecutive interhospital transports of critically ill patients to, from and between the intensive care units at Oslo University Hospital demonstrated the same morbidity and mortality compared to the total intensive care population in Norway. Critically ill patients transported between hospitals should receive the same level of surveillance, critical care, and treatment during transport as in the intensive care unit. To increase the quality and safety of interhospital transport of critically ill patients in Norway, consensus based national guidelines or standards should be made and implemented. The personnel participating should receive systematic and experience-based education.