Episode #259 Every Move Matters: Why Transport Safety Can Save Your Critical Patients

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. Have you been involved in an intrahospital transport of a critically ill patient recently? Last week, we talked about intrahospital transport adverse events and the many risk factors and complications. Did you notice any of these threats to patient safety during your transport? This week, we are excited to discuss important considerations for keeping patients safe during transport including guidelines and checklists.

Before we dive further into the episode today, we’d like to recognize BD, a major corporate supporter of APSF. BD has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, BD – we wouldn’t be able to do all that we do without you!”

We are returning to the February 2025 APSF Newsletter today. Our featured article is once again “Intrahospital Patient Transport: Checklists, Adverse Events, and Other Considerations for the Anesthesia Professional” by Caroline Andrew and Michael Fitzsimons. To follow along with us, head over to APSF.org and click on the Newsletter heading. First one down is the Current Issue. Then, scroll down until you get to our featured article today. I will include the link in the show notes as well.

Intrahospital transport adverse events may be categorised as respiratory, cardiovascular, neurological, and equipment related. Reported adverse events include the following:

• Hypertension
• Hypotension
• Arrythmias including cardiac arrest.
• Decreased arterial saturation.

Equipment-related adverse events may involve monitor, ventilator, or infusion pump malfunction, accidental dislodgement of lines, tubes, and catheters, or empty oxygen cylinders.

Last week, we reviewed Table 1 in the article for a list of adverse events, complications, and related risk factors. We are going to do a quick review now. Risk factors for patient instability during transport include age, male gender, obesity, patient condition, high APACHE score, emergent transport, longer duration transport, acidosis, elevated PaCO2, reduced pH, and higher ASA status. When there is a less experienced transport team or a lack of checklists, there is a risk for failure to respond to a crisis, improper management of devices, care delay, transport to the wrong location, or loss of information. There is an increased risk for airway and respiratory complications when patients require mechanical or manual ventilation or PEEP during transport. Risk factors for hemodynamic instability, arrythmias, central line displacement, and cardiac arrest during transport include the use of vasopressors or inotropic agents. Patients who require higher levels of sedation or do not have adequate monitoring during transport are at risk for neurologic complications ranging from agitation to seizures and increased intracranial pressure. Finally, equipment malfunction, disconnection, or failure during transport is more likely when there are more monitors used during transport, poor preparation for transport, inexperienced team, and inadequate pre-inspection of monitors and devices.

Anaesthesia professionals need to remain vigilant to help keep patient safe during transport and we have some guidelines to talk about and checklists to review. So, let’s return to where we left off in the article.

The Society of Critical Care Medicine has published guidelines for intrahospital transport of critically ill patients with a focus on four critical components of transport:

Communication

Personnel

Equipment

And Monitoring.

The communication component for safe transport involves clinician to clinician handoff when the receiving location assumes management of the patient and shares information to other involved disciplines regarding the timing of transport and equipment required. This may involve a conversation about respiratory care for the patient with the current ventilator settings or the level of sedation and infusions or the timing for the next dose of antibiotics.

The guidelines recommend a minimum of two people for the transport of a critically ill patient. This falls in the personnel component of the guidelines. Another important consideration is the experience and skills of the transport clinician who will need to have experience with airway management and advanced cardiac life support for intubation and critically ill patients. The transport team will also need to be familiar with the equipment required for transport and be able to navigate between the two locations in the hospital.

An important principle when it comes to monitoring patients during transport is that the level of monitoring should not be reduced during transport. Minimum monitoring requirements for critically ill patients must include blood pressure, pulse oximetry, and EKG.

Under the equipment component, it is important to make sure the all necessary equipment is fully charged and capable of functioning for the entirety of the transport duration. Make sure that you have all the medications that you might need for resuscitation during transport ready to go and clearly labelled.

There are additional guidelines from the American Society of Anesthesiologists regarding the transport of patients from the operating room to the post-anesthesia care unit. These guidelines states that for patients who receive general, regional, or monitored anesthesia, they need to be accompanied by a member of the anesthesia care team who is knowledgeable about the patient’s clinical condition. Anesthesia professionals are important ingredients in the safe intrahospital transport recipe following anesthesia care. During transport, it is important for anesthesia professionals to consistently assess the patient’s condition and be prepared to treat and monitor depending on their clinical judgement. Important steps to keep patients safe include regular patient and equipment checks, meticulous patient preparation, correct use of protocols, and transport locations that are within easy reach. Intrahospital transport of critically ill patients represent an excellent opportunity to use standardized transport checklists. Are you using these at your institution?

Let’s take a look at Table 2 in the article for a Perioperative Intrahospital Patient Transport Checklist. There are several systems in the list and each system has a couple critical points to address. The first system is Identification and Information. This includes:

Identification band on patient

Chart with patient

Necessary consents present

Confirm ICU/PACU/Operating Room prepared for patient

Next, we have the airway considerations including:

Endotracheal tube secured

Airway precautions necessary

Manual bag-valve mask present

Emergency airway management equipment available

Breathing is the next system with the following points:

Mode of delivery of oxygen confirmed

Oxygen supply adequate

Transport ventilator charged and functioning

Patient on ventilator

For Circulation, it is important to check the following critical points:

IV lines identified for resuscitation

Emergency medications necessary / available

Infusion pumps and monitor adequately charged

Hemodynamic alarms set

Defibrillator necessary / present

The next category is neurologic. It is important to address the following points:

Sedation / pain control adequate

Spinal precautions necessary

Patient stable / safe for movement

Some additional critical points and precautions include:

Personal protective equipment present

Lines, tubes, drains secured

Rails raised

And the final steps are:

Connect monitors

Plug in bed

Perform comprehensive hand-off

We made it through the checklist and as you can see there is nothing in that list that you want to miss in preparation for an intrahospital transport of a critically ill patient. Also, we need to return to the final step in the checklist. It was perform a comprehensive hand-off. That may seem a little daunting after going through the entire checklist process, but the good news is that we have additional resources for this. Have you heard of the Multi-Center Handoff Collaborative. This initiative is all about perioperative patient handoffs: Getting it right! The collaborative was formed in 2015 and is supported by the APSF as a special interest group to address one of its 2018 patient safety priorities, Patient-related Communication Issues, Handoffs, and Transitions in Care. For more information, head over to APSF.org and click on the patient safety resources heading. The fifth one up from the bottom is Collaborations and then, select the multi-center handoff collaborative. From here, you can check out the Handoff Education Database. Their tools include:

• General Handoff Tools
• ICU to OR Resources
• Intraoperative Resources
• OR to ICU Resources
• OR to PACU Resources
• Other Resources

Let’s take a closer look at the ICU to OR Resources. Here you will find a pocket card with all the details you need for a safe and effective handover from the ICU to the OR team prior to transport. Don’t worry, I will put the link in the show notes as well. The pocket card involves a three-step process.

Step 1 involves the ICU clinician asking, “Is everyone here?”

If Yes, then state, “Handover Time In. This is patient name, who is to undergo a procedure (state the surgery or procedure) today with surgeon name. She is a, insert age of the patient here with a primary diagnosis of fill in here and is in our ICU for, insert reason for current admission.

Now, we move on to Step 2 where the ICU physician and Bedside ICU nurse complete their checklists.

The ICU physician is responsible for addressing the following:

Patient ID and armband check

Pertinent History

End Organ Dysfunction

Abnormal Labs

Then, what they are most worried about?

Finally, does anyone have any questions?

The Bedside ICU nurse next addresses:

NPO Status

Height and Weight, Dosing and Actual

Allergies

Infusions

Access

Airway

Meds Due

Drains Tubes

Any family concerns and the location of the family.

The operating room nurse should confirm the OR consents and then should address the postoperative plan and ask any further questions.

The final step is the ICU clinician saying:

“Does anyone have any questions? Is everyone on the same page? Tag, you are now the care team.”

Is this what your handoff looks like in the ICU before bringing a patient to the operating theatre? The Handoff Education Database is an excellent resource to streamline the handoff process and improve patient safety, teamwork, and communication. We hope that you will check it out.

Now, let’s return to the APSF article for the conclusion. The authors advocate for the perioperative transport of seriously ill patients under the careful guidance of the anesthesia care team. There are increasing challenges to patient safety, from patient acuity to production pressure, to care volume, and anesthesia professionals must be proactive to increase patient safety during transport while maintaining well-being.  Here are several recommendations to achieve these goals:

1. Patient assessment before transport should include the identification of risk factors associated with ITAEs.
2. All anesthesia team members as well as others involved in patient movement should be educated on the potential harm of intrahospital transport and on proven practices that minimize these harms. This involves education about current guidelines and the use of checklists and handoff tools.
3. The use of perioperative patient transport checklists may be beneficial to assure that patients are prepared, equipment is functioning with back-up power supply, records are present, and communication has occurred. You can use Table 2 from the article. Such checklists should be used at initiation of transport, during hand-off at the receiving location, and upon return to the original location.
4. Anesthesia professionals should participate in system design when patient transport is involved. Factors to consider are uncluttered hallways, easily manoeuvrable beds and stretchers, and team formation that allows the anesthesia professional to observe the patient and intervene without distraction while other team members assume primary responsibility for patient physical bed movement.
5. Perioperative transport by anesthesia professionals should be promoted as an important focus of academic study.

Can you work on any of these recommendations at your institution? We hope that you can address some of these considerations to help improve patient safety during intrahospital transport wherever you practice anesthesia care. And we hope that you will share the resources that we talked about today, the checklist and handoff tool, with your colleagues and anyone who is involved in intrahospital transport at your institution.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

The APSF Newsletter is the official journal of the Anesthesia Patient Safety Foundation. Readers include anesthesia professionals, perioperative providers, key industry representatives, and risk managers. It is free of charge and available in a digital format with a focus on anesthesia-related perioperative patient safety issues. The June Newsletter has just been published, but the deadline for the October 2025 APSF Newsletter is right around the corner on July 1^st! Check out the guide for authors over at APSF.org for more information and I will include a link in the show notes as well. Who knows, you could be the next APSF Newsletter author, and we might be featuring your article on a future Anesthesia Patient Safety Podcast! So, what are you waiting for, go ahead and submit your article today!

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2025, The Anesthesia Patient Safety Foundation