Medical Complications of Intra-Hospital Patient Transports: Implications for Architectural Design and Research
Ulrich, Roger S., Zhu, Xuemei, HERD : Health Environments Research & Design Journal
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?
These questions raise important issues regarding the architectural design of hospitals which, as noted, has received scant attention. Do design decisions impact the frequency and severity of medical complications related to IHTs? If the answer is yes, can hospitals and other healthcare buildings be better designed so as to reduce transports and accompanying complications, and thereby improve patient outcomes, safety, and hospital efficiency? What research is available to enable evidence-based design that lessens the detrimental effects of patient transports? What studies may be needed to fill gaps in architectural research pertaining to transports?
This article first reviews selected scientific studies on medical complications during IHT, which is defined as transport of any category of patient within the hospital, not between hospitals. A "transport-related complication" is defined as any unexpected or expected event that adversely impacts a patient's stability (Lovell, Mudaliar, & Klineberg, 2001). Later sections discuss implications of the current empirical knowledge for evidence-based hospital design and suggest needs and directions for future architectural research.
The literature review was based on a search for pertinent research on PubMed and ISI Web of Science, using such keywords as "intra-hospital transport," "transport or transfer," "patient transfer," "patient," and "hospital." To be included in the review, articles had to be peer-reviewed empirical studies investigating the association between IHTs and transport-related complications, or the observed incidence and severity of complications. Non-English articles were excluded. The search identified a total of 22 articles covering the time period from 1970 to 2005 (see Appendix 1). Additionally, three other articles were included as they systematically reviewed relevant research (Branson, 1992; Stevenson, Haas, & Wahl, 2002; Waydhas, 1999). …