Assessing patients before, during, and after transport within the healthcare facility is an important strategy for mitigating potential harm to patients.¹ PA-PSRS has received several reports that discussed problems during patient transport, including the following:

Patient arrived to physical therapy without [oxygen (O₂)]. Noted in chart that patient had been on O₂ at 4L NC with O₂ saturation of 94%. Patient’s O₂ saturation on arrival to physical therapy department was 80% on room air. Heart rate was 134.

Unsupervised transport of patient with medication that required supervision of [registered nurse (RN)] and monitoring of amiodarone infusion.

Procedure for transport of patient that required monitoring was not followed. Physician was advised.

Barnes-Jewish Hospital, St. Louis, Missouri, experienced a sentinel event associated with a patient’s intrahospital transport; analysis of the event showed that policy for transporting patients with the appropriate levels of staff was somewhat unknown and inconsistently followed.² Elsewhere, in 2005, the intensive care unit (ICU) of Calgary Health Region, Canada, experienced two similar critical events during patient transport for computed tomography (CT) scans. In both cases, the patients were not intubated for transport despite compromised respiratory status. Both patients arrested during their respective CT scans.¹

A standard assessment tool to determine whether patients are stable for transport within the facility may have improved the outcomes in the PA-PSRS reports and other events discussed above. Barnes-Jewish Hospital and Calgary Health Region offer two unique tools to help healthcare facilities with patient transport.

In response to the sentinel event during transport, a multidisciplinary team at Barnes-Jewish Hospital developed a transport stability scale based on a color-coded chart to help identify and communicate a patient’s level of stability (green, yellow, red). (This chart and more information can be found at http://www.aacn.org/pdfLibra.NSF/Files/2004CSMWard/$file/2004CSMWard.pdf.) Nurses can use the chart to identify whether a physician or additional healthcare workers should accompany the patient based on the patient’s level of stability during transport (i.e., according to assessment of indicators including respiratory or cardiovascular status). Green identifies those patients who may be accompanied by a patient transporter; yellow identifies patients who need a higher level of care and accompaniment by a RN or physician; and red identifies unstable patients who require a RN and physician during transport. The RN caring for the patient uses a color-coded sticker (green, yellow, red) to identify the level of care needed, based on the patient’s most recent assessment. The appropriate sticker is placed on the front cover of the patient’s medical record, which communicates to the receiving department the patient’s stability status.  The sticker communicates information such as mode of patient travel, presence of intravenous lines, the need for oxygen during transport, isolation precautions, and the need for restraints, if necessary.²

At Calgary, a multidisciplinary team used the Barnes-Jewish transport stability scale to develop their own tool, an ICU patient transport decision scorecard. The team determined 29 steps involved with transporting a patient. The team involved a novice staff member during development to ensure, for example, that conditions were not overlooked because of inexperience. After initial testing, the team simplified their scorecard to only use the colors of green and red (see the revised scorecard and other information at www.longwoods.com/view.php?aid=18376&cat=452). Level of transport is identified according to system criteria (e.g., central nervous system, cardiovascular system). Green identifies patients to be accompanied by a RN. Red identifies patients to be reassessed by the physician and a registered respiratory therapist (RRT) and accompanied by a RN and RRT. Also, transport of patients meeting criteria in the red column “may include” another physician and RN. Nurses, RRTs, and physicians all have a role in the completion of the scorecard prior to every patient transport.¹

PA-PSRS reports have shown in several cases that healthcare facilities are encountering problems with experienced staff not present during patient transfers. Tools from Barnes-Jewish Hospital and Calgary Health Region offer possible solutions for a potential adverse outcome. PA-PSRS has addressed other matters of transport; for additional information, refer to the articles “Continuity of Oxygen Therapy During Intrahospital Transport” and “Is CT a High-Risk Area for Patient Transport?” in the September 2005 issue of the Patient Safety Advisory.

Notes

1. Esmail R, Banack D, Cummings C, et al. Is your patient ready for transport? Developing an ICU patient transport decision scorecard. Healthc Q 2006 Oct;9 Spec No:80-6.
2. Ward M, Corocoran R, Mueller J, et al. Red Light/Green Light: Who Transports the Patient? [presentation online]. [cited 2007 Aug 17]. Available from Internet: http://www.aacn.org/pdfLibra.NSF/Files/2004CSMWard/$file/2004CSMWard.pdf.