Care of critically ill patients during inter-hospital transportation: a descriptive study in Dar es salaam, Tanzania

Abstract

Background: Inter-hospital transfer (IHT) of critically ill patients (CIPs) may save lives, but it is a challenging process as it exposes them to various complications such as hypoxia, hypotension, bradycardia/tachycardia, arrhythmias, aspiration and cardiac arrest. However, little is known about care given when transporting such patients. Aim: To assess and describe the care provided to CIP during transportation from peripheral public hospitals to the tertiary referral hospital, Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methodology: A cross-sectional descriptive design, employing a quantitative approach was used. The study recruited 130 escorting personnel transporting CIP to MNH via the Emergency Medicine Department (EMD). Results: Majority of the 130 respondents were non-qualified personnel Enrolled Nurse 38.5% (50) and Health Attendants 32.3% (42), with only 8.5% who had received ambulance training. Knowledge about Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) was low 45.4% (59) and 6.2% (8) respectively among the escorting personnel. There was a little monitoring of patient’s oxygen status, respiratory rate, heart rate, and blood pressure during transportation, with no documentation provided. Among the critically ill patients, 17.7% required airway support, and 8.7% received it. Many (67) patients required oxygen; however 12 were escorted with oxygen. While 9/14 ambulances had a functional oxygen cylinder, only three had suction and one contained a portable monitor. Challenges identified by the escorting personnel included; Lack of essential equipment, lack of consumables, insufficient ambulance training and transporting more than one patient in the ambulance. Conclusion:CIP are escorted mostly by non-trained and non-qualified personnel, namely Enrolled Nurses and Health Attendants. Care/monitoring provided to such patients is suboptimal: Contributing factors include lack of a specialized transport team, lack of formal training, and minimal knowledge about BLS and ACLS. Moreover, this inadequate monitoring is also compounded by a lack of essential, required equipment and supplies in the ambulance.Recommendations: Improvement of patient safety and care during IHT requires a multi-faceted approach to educate escorting personnel and ensure fully equipped ambulances are available.