Medical Complications of Intra-Hospital Patient Transports: Implications for Architectural Design and Research

Article excerpt

Abstract

Literature on healthcare architecture and evidence-based design has rarely considered explicitly that patient outcomes may be worsened by intra-hospital transport (IHT), which is defined as transport of patients within the hospital. The article focuses on the effects of IHTs on patient complications and outcomes, and the implications of such impacts for designing safer, better hospitals. A review of 22 scientific studies indicates that IHTs are subject to a wide range of complications, many of which occur frequently and have distinctly detrimental effects on patient stability and outcomes. The research suggests that higher patient acuity and longer transport durations are associated with more frequent and serious IHT-related complications and outcome effects. It appears no rigorous research has compared different hospital designs and layouts with respect to having possibly differential effects on transport-related complications and worsened outcomes. Nonetheless, certain design implications can be extracted from the existing research literature, including the importance of minimizing transport delays due to restricted space and congestion, and creating layouts that shorten IHT times for high-acuity patients. Limited evidence raises the possibility that elevator-dependent vertical building layouts may increase susceptibility to transport delays that worsen complications. The strong evidence indicating that IHTs trigger complications and worsen outcomes suggests a powerful justification for adopting acuity-adaptable rooms and care models that substantially reduce transports. A program of studies is outlined to address gaps in knowledge.

Key Words

Patient transports, transports within hospitals, patient safety, evidence-based design, hospital design, healthcare architecture, intra-hospital transport complications, acuity-adaptable care, elevators, outcomes.

Introduction

Transport of patients within the hospital has been recognized as a pervasive and high-frequency activity with negative effects on healthcare quality. Detrimental aspects of patient transports identified by previous research include worsened rates of cross-infection (Eveillard, Quenon, Rufat, Mangeol, & Fauvelle, 2001), increased medication errors (Hendrich, Fay, & Sorrells, 2004), risk for manual lifting injuries to staff, demand for staff time, and higher care costs. Regarding costs, two similar studies of transports from intensive care units (ICUs) to diagnostic sites reported an average time requirement of 81 and 74 minutes, respectively, and monetary costs (1988 and 1992 dollars) of $465 and $612 (Hurst et al., 1992; Indeck, Peterson, Smith, & Brotman, 1988). In these studies many transports proved unnecessary, as only 24% and 39% of transports from ICUs to diagnostic sites resulted in changes of patient management. An investigation of randomly selected patient transports representing different acuity levels revealed only 12% efficiency in the transfer process (Hendrich & Lee, 2005). The great majority of transfer time was wasted by delays caused by communication breakdowns, lags in logging transfers into record or information systems, and unavailability of beds, equipment, or staff.

Despite these recognized negative effects, the literature on healthcare architecture and evidence-based design has rarely considered that IHTs may also trigger medical complications and worsen outcomes. This article focuses on the effects of transports on patient complications and clinical outcomes, and the implications of such impacts for designing better, safer hospitals. Questions addressed include: What are the complications associated with IHT? How frequent and severe are these complications? Do they happen more often for certain types of patients, or certain origins, destinations, and transport purposes? Is transport the real reason for complications and worsened outcomes or simply a proxy for the severity of illness? …