Patient care during interfacility transport: a narrative review of managing diverse disease states

doi:10.5847/wjem.j.1920-8642.2023.009

Abstract

Abstract:

BACKGROUND: When critically ill patients require specialized treatment that exceeds the capability of the index hospitals, patients are frequently transferred to a tertiary or quaternary hospital for a higher level of care. Therefore, appropriate and efficient care for patients during the process of transport between two hospitals (interfacility transfer) is an essential part of patient care. While medical adverse events may occur during the interfacility transfer process, there have not been evidence-based guidelines regarding the equipment or the practice for patient care during transport.

METHODS: We conducted searches from the PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and Scopus databases up to June 2022. Two reviewers independently screened the titles and abstracts for eligibility. Studies that were not in the English language and did not involve critically ill patients were excluded.

RESULTS: The search identified 75 articles, and we included 48 studies for our narrative review. Most studies were observational studies.

CONCLUSION: The review provided the current evidence-based management of diverse disease states during the interfacility transfer process, such as proning positioning for respiratory failure, extracorporeal membrane oxygenation (ECMO), obstetric emergencies, and hypertensive emergencies (aortic dissection and spontaneous intracranial hemorrhage).

Key words: Critically ill patients, Interfacility transfer, Interhospital transfer, Extracorporeal membrane oxygenation, Obstetric emergencies, Hypertensive emergencies

Quincy K. Tran, Francis O’Connell, Andrew Hakopian, Marwa SH Abrahim, Kamilla Beisenova, Ali Pourmand. Patient care during interfacility transport: a narrative review of managing diverse disease states[J]. World Journal of Emergency Medicine, 2023, 14(1): 3-9.

Figures/Tables 1

References 53

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Disease states	Special considerations
Respiratory failure	● Placing patient in prone position ● Secure airway and prevent dislodgment of any airway devices while patient is in prone position, through the use of anesthesia pillow and supporting head with towel rolls ● Initiating CPR with patient in prone position
Aortic dissection	● Control SBP between 100 mmHg and 120 mmHg ● Control HR <60 beats/min ● Arterial blood pressure monitor may improve guideline adherence
Intracranial hemorrhage	● Control BP <160 mmHg ● ICP monitors ● Sedative management and anti-hypertensive medication ● Securing large-pore IV access
Vaginal hemorrhage	● Consider blood product transfusion ● Provide anti-inflammatory medication
Obstetric emergencies	● Continuous fetal monitoring ● Identify cause of bleeding ● Consider transfer to high level facilities