Safety of interhospital transport of critically ill patients

Abstract

Transport of critically ill patients has been associated with significant haemodynamic complications.1 However, it has also been shown that it can be accomplished safely.2 Therefore we sought to ascertain whether interhospital transport of critically ill patients, undertaken by a specialist regional transport team, influences mortality. The SICSAG collate data collected on consecutive admissions to adult general intensive care units (ICU) in Scotland and identified 20 738 ICU admissions to 23 units between January 1, 1995 and December 31, 1997. The database of a regional specialist transport team allowed us to identify those patients transferred by the team to ICU for both bedspace problems (n = 307) and for upgraded facilities (n = 276). The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score in the Scottish population was 18.3, and the Standardized Mortality Ratio (SMR) was 0.95 with 95% confidence intervals (CI) of 0.93–0.97. Patients transferred by the regional transfer team had a mean APACHE II score for the first 24 h of ICU admission of 19 and the SMR was 0.93 (CI = 0.86–1.00). In those transferred for bedspace shortage, the mean APACHE II score was 18 and the SMR was 0.81 (CI = 0.67–0.94). For patients transferred requiring upgraded facilities the mean APACHE II score was 20.7 and the SMR was 1.06 (CI of 0.93–1.18). This preliminary analysis demonstrates no significant difference in SMR between transferred patients and ICU patients. Transport by a regional transfer team, therefore, appears not to improve mortality. In comparison with the overall SMR for transferred patients, there are trends for lower SMR for bedspace transfers and higher SMR for upgrades. Although these do not reach statistical significance, they presumably reflect the different case mix of the two groups.