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

By Ulrich, Roger S.; Zhu, Xuemei | HERD : Health Environments Research & Design Journal, Fall 2007 | Go to article overview
Save to active project

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


Ulrich, Roger S., Zhu, Xuemei, HERD : Health Environments Research & Design Journal


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?

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

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

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?