Assessment of intrahospital transfer practice of critically ill patient at Muhimbili Orthopedic Institute, in Dar es Salaam

Abstract

INTRODUCTION Intra-hospital transfer of critically ill patients is a challenging task. Patient monitoring during intra-hospital transfer is an important safety issue. Frequent monitoring facilitates, timely interventions and improve outcome during intrahospital transfer. MAIN OBJECTIVE Assessment of intrahospital transfer practice of critically ill patients admitted and managed at Muhimbili Orthopedic Institute from March.2021 to May.2021 STUDY DESIGN Prospective cross-sectional study, was conducted for a period of three months at ICU/EMD of Muhimbili Orthopedic Institute (MOI). Consecutive sampling technique was used to recruit eligible critically ill patients needing intrahospital transport during the study period. The Researcher observed and filled data in Data Extraction Form immediately after intrahospital transport process has taken place. Then data was coded, analyzed using SPSS (version 23), then findings were presented in form of tables, graphs or charts. RESULTS A total of 184 critically ill patients were recruited during study period, of whom 60(32.6%) were females and 124(67.4%), were males. These patients had working or provisional diagnosis of either severe head injury, hemorrhagic stroke or brain tumor. A total of 159(86.9%) of all patients were on oxygen therapy, of whom 89 (54.9%) were intubated and 74(40.4%) needed mechanical ventilation. Transport destination areas were CT Scan 82(40.6%), the MRI room 16(8.7%), the ICU 59(32.1) and the Operating Rooms 25(13.6). The study showed existence of good communication before patient transfer and a less than adequate monitoring practice of patients during transfer. But lack of dedicative emergency box, intrahospital transfer protocol and multiparameter portable monitor contributed to occurrence of adverse event such as oxygen desaturation 11(16.1%), tachypnea 54 (79.4%), tachycardia 50 (89.2%) and hypertension 50 (49.5%) which were picked after patients have reached ICU CONCLUSION AND RECOMMENDATIONS Intrahospital transfer of critically ill patients involve moving patients to and from Emergency Unit/ ICU, to and from radiology suite or to and from operating theaters for diagnostic and therapeutic procedures. This study has revealed that currently intrahospital transfer of critically ill patient in our hospital faces few challenges. Transport team members use their knowledge and skills to provide smooth transport in the midst of a resource constrained environment. The non-availability of intrahospital protocols, patient preparation checklist, and standard emergency box were evident, and multiparameter portable patient monitors were inadequate (1 multiparameter monitor) for the size of the health care facility. Since the availability of these is a necessity for the early detection and intervention of any adverse event during intrahospital patient transfer I do recommend all efforts are made to put them in place