Patients are routinely transported to various locations within the hospital, but that doesn’t mean it is without risk. Regardless of whether a transport is emergent or non-emergent, careful thought should be given to the process, so that the patient is provided with a consistent and safe level of care.
The Agency for Healthcare Research and Quality (AHRQ) provides a useful list of questions to be considered before every patient transport. By addressing the “why, who, what, when and where” of the transport, you can be certain to cover all the bases.
This addresses the risk-benefit ratio of the need for transport. Because there is a risk associated with moving the patient to another location, you want to make certain it is necessary. A life-saving surgery would obviously necessitate a transport, but a diagnostic x-ray could perhaps be done at the bedside instead.
“Who” looks at the patient. This includes knowledge of the patient’s medical history and the reason for the transport. It also assesses the patient’s stability and tolerance for the test or procedure.
“Who” also refers to who will be needed to accompany the patient during and after transport. A stable patient may only require transport personnel. However, more critically ill patients may need a nurse, respiratory therapist or physician to attend the transport. If the patient will be handed-off to another care provider at the transport destination, the patient’s care plan must be fully communicated to the oncoming provider. Handoffs are a frequent source of patient care errors, so close attention should be paid to this step.
Think about what equipment is needed during the transport based on the ABC’s- airway, breathing and circulation. Maintaining a patent airway is critical, so consider your patient’s status. Make certain your intubated patients have a secure endotracheal tube and pay attention to the depth of placement. Have a portable suction device available since secretions may be mobilized during the movement of transport. A portable ventilator would be needed as well. Keep in mind that non-intubated but unstable patients could have an airway emergency during transport and make sure to have the necessary supplies to manage the situation.
Unstable patients should be placed on cardiac and respiratory monitors with continuous pulse oximetry. Check all IV insertion sites. If IV fluids or medications need to be continued during the transport, make sure you have an adequate amount to infuse and that your IV pumps are fully charged.
The timing of the transport should be appropriate for the patient. Consider things such as when the patient eats, when important medications are given, and when the patient receives respiratory treatments and suctioning. Also, plan ahead if possible, so that necessary team members are available and that the transport destination is ready. The goal is for a smooth transport without unnecessary waiting time.
Identify the best route to the transport destination. Keep in mind elevator locations, crowded areas of the hospital, and access to emergency supplies along the route.
These five simple questions will make you think through your patient’s transport, anticipate any potential difficulties, and address them in advance. Doing so will allow you to provide consistently high quality patient care and a safe transport.