Incidence and Risk Factors of Clinical Deterioration during Inter-Facility Transfer of Critically Ill Patients; a Cohort Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Critically ill and injured patients are at a higher risk of developing clinical deterioration during inter-facility transfers. This study aimed to determine the incidence rate and risk factors of clinical deterioration among critically ill patients during inter-facility transfers in Thailand.
Methods: The present cohort study was conducted in 22 referring hospitals and 7 receiving hospitals under the supervision of Ministry of Public Health, Thailand, between March 15 and December 31, 2018. The subjects were comprised of 839 critically ill patients aged 18 and over, 63 coordinator nurses in referral centers, and 312 referral team leaders. Data collected included pre-transfer risk score, clinical data of patient during transfer, characteristics of referral team leader, ambulance type, preparation time, time to definitive care, transfer distance, and National Early Warning Score (NEWS) (clinical deterioration). Multilevel mixed-effects regression analysis was performed. Results: The incidence rate of clinical deterioration was 28.69%. The most common types of clinical deterioration were hemodynamic instability, respiratory instability, and neurological alteration. Time between 31-45 minutes was significantly associated with clinical deterioration (β 0.133, P value 0.027). The following illnesses were associated with higher probability of clinical deterioration: body region injuries/head injury/burn/ingested poison (β 0.670, P value 0.030), respiratory distress/convulsion (β 0.919, P value 0.001), shock/ arrhythmias/chest pain/hemorrhage (β 1.134, P value <0.001), comatose/alteration of consciousness/syncope (β 1.343, P value <0.001), and post-cardiac arrest (β 2.251, P value <0.001). Patients with unstable conditions (β 1.689, P value 0.001) and pre-transfer risk score of 8 or higher (β 0.625, P value 0.001) had a higher rate of deterioration. Transfer by non- emergency room (ER) nurses (β 0.495, P value 0.008) and transportation in a mobile intensive care unit (ICU) were associated with a higher rate of deterioration (β 0.848, P value 0.001).
Conclusion: The incidence of clinical deterioration during inter-facility transfer in Thailand was high. Illnesses involving circulatory, respiratory, and neurological systems, clinical instability, high pre-transfer risk score, transport time of 31-45 minutes, transportation by non-ER nurse, and mobile ICU were associated with a higher rate of clinical deterioration.
- Patient transfer
- critical illness
- clinical deterioration
How to Cite
Ligtenberg JJM, Arnold LG, Stienstra Y, van der Werf TS, Meertens JHJM, Tulleken JE, et al. Quality of interhospital transport of critically ill patients: a prospective audit. Crit Care. 2005;9(4):R446.
van Lieshout EJ, Binnekade J, Reussien E, Dongelmans D, Juffermans NP, de Haan RJ, et al. Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial. Intensive Care Med. 2016;42(7):1146-54.
Alabdali A, Trivedy C, Aljerian N, Kimani PK, Lilford R. Incidence and predictors of adverse events and outcomes for adult critically ill patients transferred by paramedics to a tertiary care medical facility. J Health Spec. 2017;5(4):206.
Singh JM, MacDonald RD, Ahghari M. Critical events during land-based interfacility transport. Ann Emerg Med. 2014;64(1):9-15. e2.
Lee LLY, Lo WYL, Yeung KL, Kalinowski E, Tang SYH, Chan JTS. Risk stratification in providing inter-facility transport: experience from a specialized transport team. World J Emerg Med. 2010;1(1):49.
Markakis C, Dalezios M, Chatzicostas C, Chalkiadaki A, Politi K, Agouridakis PJ. Evaluation of a risk score for interhospital transport of critically ill patients. Emerg Med J. 2006;23(4):313-7.
Wiegersma JS, Droogh JM, Zijlstra JG, Fokkema J, Ligtenberg JJM. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team. Crit Care. 2011;15(1):R75.
Strauch U, Bergmans DCJJ, Winkens B, Roekaerts PMHJ. Short-term outcomes and mortality after interhospital intensive care transportation: an observational prospective cohort study of 368 consecutive transports with a mobile intensive care unit. BMJ open. 2015;5(4).
Droogh JM, Smit M, Absalom AR, Ligtenberg JJM, Zijlstra JG. Transferring the critically ill patient: are we there yet? Crit Care. 2015;19(1):62.
Fan E, MacDonald RD, Adhikari NK, Scales DC, Wax RS, Stewart TE, et al. Outcomes of interfacility critical care adult patient transport: a systematic review. Crit Care. 2005;10(1):R6.
ATOTW 330-Physiological effects of transfer for critically ill patients [Internet]. 2016 [cited 28th June 2017]. Available from: https://www.wfsahq.org/components/com_virtual_library/media/e25fd136d2b7ebef4092cd6b949dab52-330-Physiological-effects-of-transfer-for-critically-ill-patients.pdf.
Ambulance Services, Reliability Problems and Potential Technologies [Internet]. 2010 [cited 28th Octpber 2018]. Available from: https://web.wpi.edu/Pubs/E-project/Available/E-project-042910-085147/unrestricted/IQP_for_Submissionlin.pdf.
Scherbaum CA, Ferreter JM. Estimating statistical power and required sample sizes for organizational research using multilevel modeling. Organizational Research Methods. 2009;12(2):347-67.
Faine BA, Noack JM, Wong T, Messerly JT, Ahmed A, Fuller BM, et al. Interhospital transfer delays appropriate treatment for patients with severe sepsis and septic shock: a retrospective cohort study. Crit Care Med. 2015;43(12):2589-96.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-82.
Groarke JD, Gallagher J, Stack J, Aftab A, Dwyer C, McGovern R, et al. Use of an admission early warning score to predict patient morbidity and mortality and treatment success. Emerg Med J. 2008;25(12):803-6.
Imhoff BF, Thompson NJ, Hastings MA, Nazir N, Moncure M, Cannon CM. Rapid Emergency Medicine Score (REMS) in the trauma population: a retrospective study. BMJ open. 2014;4(5):e004738.
Lee LLY, Yeung KL, Lo WYL, Lau YSC, Tang SYH, Chan JTS. Evaluation of a simplified therapeutic intervention scoring system (TISS-28) and the modified early warning score (MEWS) in predicting physiological deterioration during inter-facility transport. Resuscitation. 2008;76(1):47-51.
Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465-70.
Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. Report of a working party. London: Royal College of Physicians
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