Incidence and Risks of Perioperative Transport 

Perioperative transport plays a crucial role in patient care, allowing for the transfer of individuals to various locations within a healthcare facility or even between healthcare facilities for diagnostic imaging, surgical procedures, or postoperative recovery. However, this process is not without risks, and these risks are thought to be independent of the duration of hospitalization [1]. Understanding the incidence and risks associated with perioperative transport is essential to ensure patient safety and promote optimal care and outcomes. 

Risks of perioperative transport for the patient include risk of patient falls and injuries, discomfort, anxiety, and hemodynamic instability.  The risk of falls and injuries is low but possible during perioperative transport, particularly when patients are required to navigate unfamiliar surroundings or experience postoperative side-effects (e.g., dizziness, weakness). This is especially relevant for orthopedic and neurosurgery patients where monitoring and stabilization is important [1]. Further, hemodynamic changes during transport are a major source of concern and can lead to hypotension, arrhythmias, or cardiac arrest [5].  

Other risks during perioperative transport include airway or pulmonary complications such as hypoxia, atelectasis, increased risk of a pulmonary embolism, or exacerbation of underlying pulmonary conditions. Patients who are intubated or require mechanical ventilation add an additional layer of complexity and room for problems during transport [2]. Patient transport can also increase the risk of healthcare-associated infections both for the patient being transported and those who may be exposed to the transported patient. Some studies have shown a 4-fold increase in the risk of ventilator-associated pneumonia in patients who underwent transport out of the ICU [1,7]. Finally, many issues surrounding transport may be attributed to problems with equipment which can often lead to medical errors, such as incorrect dosing or inadequate monitoring [3]. 

Thorough preoperative evaluations can identify patients at high risk for complications during transport, enabling appropriate intervention and optimization. Further, benefits of intrahospital transport must outweigh the risks especially in the case of transporting for diagnostic tests which may not alter a patient’s care [1]. The Society of Critical Care Medicine established guidelines for intrahospital transport of critically ill patients to standardize transport decisions and recommendations [4]. Using these guidelines, it is possible to provide comprehensive training to healthcare personnel involved in patient transport, including techniques for safe handling, infection control measures, and recognizing potential complications in order to mitigate risks. Further, emphasis must be placed on effective communication between healthcare providers, including the perioperative team and transport personnel. Standardizing transport equipment, including stretchers, monitoring devices, and intravenous pumps, can improve familiarity and reduce the likelihood of errors. Implementing strict infection control protocols, including proper hand hygiene, cleaning and disinfection procedures, and adherence to personal protective equipment guidelines, can minimize the risk of infection transmission during transport. 

To conclude, perioperative transport is an essential aspect of patient care, but it comes with risks. By understanding these risks, following guidelines, and implementing appropriate strategies, healthcare facilities can enhance patient safety and improve overall outcomes during the perioperative period.  

References 

1. Knight, P. H., Maheshwari, N., Hussain, J., Scholl, M., Hughes, M., Papadimos, T. J., Guo, W. A., Cipolla, J., Stawicki, S. P., & Latchana, N. (2015). Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention. International journal of critical illness and injury science, 5(4), 256–264.  

2. Schwebel C, Clec’h C, Magne S, Minet C, Garrouste-Orgeas M, Bonadona A, et al. OUTCOMEREA Study Group. Safety of intrahospital transport in ventilated critically ill patients: A multicenter cohort study*. Crit Care Med. 2013;41:1919–28. 

3. Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med. 2004;30:1579–85. 

4. Warren J, Fromm RE, Jr, Orr RA, Rotello LC, Horst HM. American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32:256–62. 

5. Nakayama DK, Lester SS, Rich DR, Weidner BC, Glenn JB, Shaker IJ. Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients. J Pediatr Surg. 2012;47:112–8. 

6. Kollef MH, Von Harz B, Prentice D, Shapiro SD, Silver P, St John R, et al. Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest. 1997;112:765–73.