You are on page 1of 8

International Journal for Quality in Health Care 2011; Volume 23, Number 1: pp. 68 –75 10.

1093/intqhc/mzq076
Advance Access Publication: 1 December 2010

Non-emergency patient transport:


what are the quality and safety issues?
A systematic review
ISLA M. HAINS, ANNE MARKS, ANDREW GEORGIOU AND JOHANNA I. WESTBROOK
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, The University of New
South Wales, Sydney, Australia
Address reprint requests to: Isla M. Hains, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation,
Faculty of Medicine, Level 1 AGSM Building, The University of New South Wales, Sydney NSW 2052, Australia. Tel: þ61-2-9385-3960;
Fax: þ612-9385-8280; E-mail: i.hains@unsw.edu.au

Accepted for publication 5 November 2010

Abstract
Purpose. Patient transportation is an important component of health-care delivery; however, the quality and safety issues relating
to non-emergency patient transport services have rarely been discussed compared with the transport of emergency patients. This
systematic review examines the factors associated with the quality and safety of non-emergency transport services.
Data sources. Medline, Pre-Medline, CINAHL and Embase databases were searched for publications between 1990 and

Downloaded from by guest on March 22, 2016


September 2009.
Study selection. Articles investigating non-emergency hospital transport services.
Data extraction. Study characteristic and outcome data were abstracted by one author and reviewed by a second and third
author.
Results. Twelve articles from seven countries were included. Five studies examined issues relating to the structure of transport
services, which focused on the use of policies and protocols to assist the transfer process. All studies addressed factors associ-
ated with the transfer process such as communication, appropriateness of personnel, time to arrange transfers, and the safety
and efficiency of the process. Outcomes were measured in one study.
Conclusions. Communication, efficiency and appropriateness are key factors that are advanced as impacting on the quality and
safety of non-emergency transport services. Standardization of the non-emergency transport process shows promise in reducing
risk and increasing efficiency. Applying information and communication technology to improve the quality of transport services
has received little attention despite its potential benefits. Patient outcomes in relation to quality and safety of transport services
are rarely measured. Available evidence suggests that safety of non-emergency patient transfers is sometimes compromised due
to poor standardization and failures in communication processes.
Keywords: transportation of patients, quality of health care, patient safety, ambulances, patient transfer

Introduction spent $A2 billion on patient transport services, an annual


increase of 8.5% [1]. A significant cause of this rise is the
Patient transportation is a major activity in health care with increased specialization of many health-care services requir-
significant resource implications for health systems [1]. Much ing patients to move between facilities in order to access
attention has focused on the emergency transport of acute- appropriate services [4, 7 – 13].
and critical-care patients [2, 3]. However, a large percentage While rarely discussed in the health-care literature,
of patient transportations are of a non-urgent nature [4 – 6]. non-emergency patient transfers entail inherent safety risks
These involve the transport of patients between hospitals, for patients. These patients, many of whom are seriously
rehabilitation services, nursing homes and patients’ homes. and/or chronically (but not critically) ill, have needs similar
Reports from several countries show that these non-urgent to those of emergency patients, in terms of requiring the
transfers are continuing to grow at significant levels [4 – 6]. appropriate equipment, staff and support during transpor-
For example, in 2007 – 2008, the Australian government tation [14]. Growing costs and safety concerns regarding

International Journal for Quality in Health Care vol. 23 no. 1


# The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care;
all rights reserved 68
Patient transport services

non-emergency transfers have been raised [15, 16]. Issues Table 1 Search strategy
include depending upon emergency ambulances for non-
urgent transfers resulting in unnecessary cost, and potentially Medline (1990 –September 2009)/Pre-Medline
long delays until an emergency vehicle is available, which 1 exp Hospitals/
may also impact on patients’ care [4, 17, 18]. Such concerns 2 patient transfer.mp. or exp Patient Transfer/
have resulted in attempts to establish policies for effective 3 transportation of patients.mp. or exp ‘Transportation of
and safe non-emergency transport services [13, 17, 19 – 21]. Patients’/
However, the evidence-base to inform such policy develop- 4 (patient$adj1 transport$).tw.
ment remains largely unappraised. 5 2 or 3 or 4
Our objective was to conduct a systematic review of the 6 exp academic medical centers/or exp ambulatory care
evidence regarding non-emergency patient transport services, facilities/or exp health facilities, proprietary/or exp
with a particular focus on factors impacting upon the quality hospital units/or exp physicians’ offices/
and safety of services. 7 1 or 6
8 5 and 7
CINAHL (1990 –September 2009)
Methods 1 (patient transfer) or (MH ‘Transfer, Discharge’)
2 (‘transportation of patients’) or (MH ‘Transportation of
Search strategy Patientsþ’)
A systematic search of the literature from 1990 to September 3 patient* N1 transport*
2009 was performed using Medline, Pre-Medline, CINAHL 4 (MH ‘Hospitalsþ’)
and EMBASE databases. Search strategies were specific to 5 1 or 2 or 3
the database and included Medical Subject Headings (MeSH) 6 (MH ‘Academic Medical Centers’) or (MH ‘Ambulatory
associated with key words. Only English full-text papers pub- Care Facilitiesþ’) or (MH ‘Hospital Unitsþ’) or (MH
lished in peer-reviewed journals were selected for further ‘Practitioner’s Office’)
review. Reference lists of relevant articles were hand searched 7 4 or 6

Downloaded from by guest on March 22, 2016


to supplement this process. Table 1 shows the search strategy 8 5 and 7
used to identify articles. Embase (1990 – September 2009)
We identified eligible studies through the process outlined 1 ‘patient transport’/exp OR ‘patient transport’
in Fig. 1. We were unable to find a clear definition of 2 ‘transportation of patients’
non-emergency hospital transport [17, 20, 22]. For the 3 (patient* NEAR/1 transport*): ab,ti
purpose of this review, the term non-emergency transport 4 ‘patient transfer’/exp OR ‘patient transfer’
was defined as transport that is available for low-, medium- 5 1 or 2 or 3 or 4
and high-acuity patients, which could potentially include 6 (‘hospital service’/exp OR ‘patient escort service’/exp
seriously ill patients requiring clinical skills, but not for OR ‘hospital’/exp OR ‘outpatient department’/exp
patients whose condition is life-threatening or time-critical 7 5 and 6
[17]. The literature shows no clear distinction between
‘transport’ and ‘transfer’. While transfer can often refer to
intra-hospital situations, we deemed it necessary to include (‘what is actually done in giving and receiving care’) and
‘transfer’ in our searches. outcome (‘the effects of care on the health status’) [23].
These categories are not mutually exclusive and as such,
some studies were included in more than one category
Data extraction according to the outcomes measured.
A data-abstraction table captured information relevant to the
review question, including country, setting, study design, par-
ticipants, sample size, aim, outcome measures, results and Results
secondary outcomes. We also collected data that related to
communication, safety, information technology, quality, clini- Our initial database searches yielded 5739 references (Fig. 1).
cal skills and limitations. Authors of the included studies After reviewing the titles and abstracts, we excluded 5662
were contacted where necessary for further clarification of articles and 77 papers were read in full-text form. Of these,
details. Data from the studies were abstracted by A.M., 12 articles met our inclusion criteria. A full summary of
reviewed by I.H. and A.G. and checked for missing or study characteristics and results are given in Supplementary
incomplete data. material, Table S1.

Data synthesis Study characteristics


We categorized the research findings according to their Four studies were conducted in the USA [24 – 27], four in
impact on structure (‘attributes of the setting’), process Europe [28 – 31], three in Australia [32 – 34] and one in

69
Hains et al.

wards, found that only 10% of trusts had a transfer policy


applicable to these patients. Similarly, a study by Hickey and
Savage [27] looking at the issues affecting the quality of care
for inter-hospital transfers established that doctors in six of
eight medical centres in the USA had insufficient knowledge
of the policy that detailed the requirements for inter-hospital
transfers. The authors commented that non-compliance with
policies likely resulted in the problems they identified in the
transfer process, such as poor communication and inap-
propriate transport mode or accompanying personnel. A
study by Lee et al. looked at the effectiveness of an
educational programme for a sample of Australian clinicians
(n ¼ 43) in the use of guidelines about inter-hospital transfer
procedures and how to arrange appropriate escorts. The
guidelines allowed the clinicians to check their patients’ con-
dition ( physiology, treatment and diagnosis) on a colour-
coded chart. The colour relating to the patient’s condition
determined the level of escort required. They found that
3 months post-training, 29 participants had the need to
arrange transfers. Of these, 89% reported using the guide-
lines to assist them to make informed decisions when trans-
ferring patients [34].
Casey et al. [25] used an expert panel to identify a number
of safety interventions relevant for small and rural hospitals
and concluded that standard protocols for inter-facility trans-

Downloaded from by guest on March 22, 2016


fers would be both valuable and easy to implement as an
intervention. Two studies (Antwi et al. [31] and Crandon
et al. [35], respectively) considered issues of the distance to
be transported and the equipment required during transfer
and their impact on patient risk of harm during a
non-emergency transfer.

Process
Figure 1 Process by which studies were included in the All studies addressed issues related to the transport process
review. [24 – 35]. Communication factors were addresses in over half.
Most studies (n ¼ 6) reported that communication in the
transfer process was inadequate. Hickey and Savage [27] and
Jamaica [35]. Study designs were either retrospective or pro- Crandon et al. [35] highlighted poor documentation, includ-
spective in nature and included eight audits [24, 26 – 30, 33, ing incompleteness, legibility and missing patient records, at
35], three surveys [27, 31, 34], one observational study [32] the transferring and receiving facilities. Hickey and Savage
and one based on consensus by expert panel [25]. Only three also found poor verbal communication between staff at both
papers measured an intervention [26, 30, 34]. Six studies facilities, particularly between nurses. Delayed communication
were undertaken prior to 2000 [24, 26, 27, 29, 33, 34], between facilities was identified as a reason for both delays
while three did not report when the study was carried out [28] and long transfer times for non-priority patients [24]. In
[30, 31, 34]. an observational study to describe the inter-hospital transfer
process, Craig [32] reported that an average of 4.7 telephone
calls per patient was required to facilitate an inter-hospital
Structure
transfer. Use of satellite phones by ambulance crews to allow
Five papers measured a structural element of non-emergency them to have continual contact with clinicians at receiving
transport services [25, 27, 31, 34, 35]. Several studies investi- facilities was judged as one strategy to improve inter-transfer
gated the presence and application of policies and guidelines communication by Casey et al. [25] in their study looking at
for non-emergency transfers. Although limited in their safety interventions. Geehr et al. [26] assessed a newly estab-
scope, these studies reveal an absence of policies or good lished transfer centre to manage transfer requests in response
knowledge of their contents when available. For example, a to an increasing number of requests for inter-facility transfer,
survey of six acute trusts in the UK by Antwi et al. [31], many of which were deemed inappropriate. They reported
examining the transfer of patients with mental illness from improved communication between the transferring and
the emergency department (ED) to acute mental health receiving facilities. The use of a computerized system for

70
Patient transport services

collecting data allowed the centre to store a record of all non-urgent patients (10 vs. 38 min) and the ED length of
transfers and produce a weekly activity report. stay was also shorter than for emergency patients (219 vs.
Five studies addressed the nature of personnel used to 243 min) [32].
accompany patients during transportation. The use of Four studies highlighted the importance of safe patient
inadequate or inappropriate escorts was reported in two transfers. Antwi et al. [31], Hickey and Savage [27] and
studies. An audit conducted by Deane et al. [33] in an Crandon et al. [35] all recommended the use of standardized
Australian hospital to examine the appropriateness of trans- protocols or transfer forms to ensure appropriate transport
fers found that 15 of 47 (32%) patient transfers ought to and medical supervision of the patient during transfer, as well
have been accompanied by a staff member who was more as the documentation of essential patient information.
appropriately qualified to ensure the safety of the patient. Crandon et al. reported that injured patients were not being
The study of Crandon et al. in an attempt to evaluate the safely transferred, as 55% of road-traffic-accident patients in
inter-hospital transfer process in Jamaica reported that 89% their Jamaican study sample did not receive cervical immobil-
of patients did not have an accompanying doctor during ization during transfer. A Spanish study by Etxebarrı́a et al.
their transfer due to the unavailability of suitably qualified [29] looked at the impact of risk scores to ensure safe inter-
medical staff, and the majority of transfers were arranged by hospital transport. The risk involved in transferring the
junior medical staff (94%), contrary to international guide- patient was evaluated using a standard protocol containing 11
lines [35]. In contrast, the majority of survey respondents in individual items (such as ‘haemodynamics’, ‘arrhythmias’,
the study by Antwi et al. [31] of UK mental health patient ‘ECG monitorization’, ‘intravenous line’, ‘respiratory support’
transfers reported the use of appropriate personnel. and ‘technopharmalogical support’), which were given scores
Approaches to ensure appropriate escort personnel were from 0 to 2. The individual scores were combined and the
examined in two studies. Wasserfallen et al. developed an patient was given a final risk score, which fell into a low- or
algorithm (which classified patients according to their trans- high-risk category. These scores allowed the assignment of
fer destination, equipment required for transfer and their appropriate clinical staff and transport vehicles to each patient
medications) to assess transport risk, thus determining that required a transfer. They subsequently found that there
appropriate personnel for transport. A transfer centre was set was a low incidence of complications during transfer and con-

Downloaded from by guest on March 22, 2016


up, which received bookings via computer to book transport cluded that the use of risk scores facilitated safe transfers.
according to the algorithm results [30]. This led to a decrease The efficiency of the transport system was investigated in
in unsafe transfers from 6% to 4%. However, ‘safer than four studies. A transfer centre, described by Geehr et al. [26],
necessary’ transfers increased from 0 to 20% with over- improved the efficiency of resource utilization, reducing the
qualified personnel accompanying patients. Similarly, the pre- numbers of medically inappropriate transfers (though no
viously described Australian study by Lee et al. established quantification of this was reported) or ‘transfers of conven-
that education in the use of guidelines to aid the clinician in ience’ with only 1% of transfer requests denied. They also
deciding on suitable personnel decreased the error rate reported that the coordinating centre resulted in annual
of staff arranging inappropriate escorts from 35% to 14% ‘savings’ of US$550 000. Deane et al.’s [33] Australian study
3 months post-training [34]. reported that almost half of all transfers to an ED were inap-
The time a non-urgent patient spent in waiting to be propriate. Delays in the transfer process were commented on
transferred was examined in four studies with three showing by Alraqi and Coughlan [28], Craig [32] and Deane et al. [33]
that delays were common. Ammon et al. reviewed the length and drew attention to factors such as transport availability,
of time 116 paediatric patients spent in a Level-II trauma waiting for test results, shift changes, bed availability and arran-
centre in the USA before being transferred to a paediatric ging personnel, which could all play a role in transfer delays.
trauma centre [24]. They found that the overall time taken
was significantly longer for non-priority patients than for pri-
Outcome
ority patients; however, the authors did not comment on the
potential care implications of this outcome. The audit con- Outcomes were measured in only one study [29]. Etxebarrı́a
ducted by Deane et al. [33] found that 20% of patients were et al. found that the in-hospital mortality rate within the first
delayed at the sending hospital, which—according to their 24 h of transfer or thereafter in hospital was greater for
conclusion—could negatively affect patient management and patients categorized as high risk compared with those at low
outcomes. Similarly, Alraqi and Coughlan [28] audited the risk (14 vs. 9 patients and 6 vs. 0 patients, respectively).
transfer time for patients to reach the receiving hospital, after Likewise, the length of stay in the intensive care unit (1.3 +
referral by an ED officer at the sending hospital. They found 3.4 vs. 9.4 + 14.6 days) and in the hospital (14.6 + 15.8 vs.
that the transfer time was unacceptable for 60% of patients 30.5 + 36.7 days) was significantly lower for the low-risk
and that transfer delays hindered the care given to the patients.
patients. However, they indicated that further research was
required to determine the consequences of this. Craig looked
at the time taken for a proposed transfer to be accepted Discussion
together with the total time a patient spent in an Australian
ED before transfer. Time for a transfer agreement to We have conducted the first known systematic review on the
be made after the first phone call was significantly less for quality and safety factors associated with non-emergency

71
Hains et al.

Figure 2 Key issues impacting on the quality and safety of non-emergency hospital transport.

hospital transport services. We identified 12 studies from 7 Communication-related factors were discussed in over half
different countries. The limited evidence base, made up of the studies. Many highlighted the lack of (or delayed) com-

Downloaded from by guest on March 22, 2016


an eclectic mix of study designs, suggests that there remains munication when organizing for patients to be transported
a lot to understand and explore in this area. Moreover we between facilities and how this may affect time to treatment
found that there is no consistent and recognized definition and patient outcomes [32]. Patient information is also often
of ‘non-emergency transport’. The external validity of the poorly documented between health-care providers [27, 35].
studies was also an important issue with four studies limited
in the generalizability of their results due to small sample
Efficiency
sizes and the study context [24, 30 – 32]. All studies were
conducted at a single site with the context specific to each While non-emergency patient transport is not time-critical
site playing a significant role in defining each study and its for the patients, a degree of efficiency in the process is still
outcomes. required for the patients to get to the ‘right place at the right
Despite the limitations and variability of the evidence time’ [14]. There is some limited evidence that poor effi-
base, the results highlight key factors where there is some ciency can lead to increased costs for the hospital, longer
evidence to suggest their impact on the quality and safety of hospital stays and patient anxiety [18, 42]. While little
non-emergency transport services. These factors are illus- research appears to have been conducted regarding the
trated in Fig. 2. Communication relates to the consultations impact of transfer time on patient outcomes, a study by
between facilities to arrange transfers and the flow of infor- Belway et al. [43] showed an association between the time
mation between sending and receiving facilities. Efficiency taken to transport critically ill patients and an increased
describes how proficiently the transport service is organized, length of stay in hospital. Time delays in transportation
the timeliness of the transfer and effective resource utiliz- were observed in a number of studies; however, the
ation. Appropriateness relates to the manner in which the trans- impact of these on patient care were not measured or dis-
portation is conducted and its necessity. cussed [28, 32].

Appropriateness of transfer
Communication
The literature suggests that the ambulance transfer of
Communication is an integral part of the health-care process non-emergency patients is often ‘medically unnecessary’,
and is identified by the World Health Organization as a key taking up resources that could be utilized more efficiently
patient-safety priority [36] because poor communication, par- [4, 44]. It has been argued that, personnel ought to be suffi-
ticularly in relation to patient handover, can lead to errors in ciently trained in how to safely and appropriately transport
care with one report commenting that 11% of preventable patients [45, 46]. Several studies in our review discussed the
adverse outcomes are a result of this [37 –41]. Inadequate appropriateness of transfers. Most frequently this issue has
communication also has important consequences for the effi- been addressed via guidelines for patient transport [47 – 49],
ciency of the health-care process [37, 38]. and while these focus specifically on critically ill patients, the

72
Patient transport services

Only one study measured patient outcomes [29] and thus


little is known about the impact that the problem areas ident-
ified have on patient care.
Despite potential quality and safety implications associated
with poor transport, there is clearly a lack of research evi-
dence for guiding the design of effective interventions. The
distilled evidence from this review provides the first building
block by bringing together what is known and providing an
initial framework for future investigations.

Figure 3 Recommendations as a result of this review. Supplementary material

requirements are equally relevant to the transportation of Supplementary material is available at International Journal for
non-emergency patients. However, guidelines to help regulate Quality in Health Care online.
inter-hospital transport were not in place or followed in
several studies [27, 31, 35]. Lee et al. [34] demonstrated that
education on the use of guidelines allowed clinicians to make Funding
more appropriate decisions regarding accompanying person-
nel when organizing inter-hospital patient transportation. This review was supported by an Australian Research
Such training is advocated by others to facilitate the uptake Council linkage grant in partnership with Sydney South West
of guidelines thus ensuring more appropriate care of patients Area Health Service (LP0989144). The funding source had
while being transported [50, 51]. no role in the design, conduct or reporting of this review.

Downloaded from by guest on March 22, 2016


Limitations References
The indexing of studies in this area is not consistent and
so although we used a broad search strategy, it is possible 1. Australian Institute of Health and Welfare, Health expenditure
that we did not capture all available peer-reviewed literature. Australia 2007–08. http://www.aihw.gov.au/publications/hwe/
hwe-46-10954/hwe-46-10954.pdf (6 January 2010, date last
While the grey literature often contains interesting and rel-
accessed).
evant information, we chose not to include this in our
search as it generally consists of policies and strategic plans 2. Belway D, Henderson W, Keenan SP et al. Do specialist trans-
based on evidence that may not be easily verified. Lastly, port personnel improve hospital outcome in critically ill patients
we may have missed articles in languages other than transferred to higher centers? A systematic review. J Crit Care
2006;21:8 –17.
English.
3. Fan E, MacDonald RD, Adhikari NKJ et al. Outcomes of inter-
facility critical care adult patient transport: a systematic review.
Recommendations Crit Care 2006;10:R6.
4. Robinson V, Goel V, Macdonald RD et al. Inter-facility patient
Many studies in our review discussed the need to standardize
transfers in Ontario: do you know what your local ambulance is
processes. Clearly defined protocols and procedures are a being used for? Healthc Policy 2009;4:53 –66, e1-e4.
solution for standardization and are supported in the litera-
ture as the key to improving quality and safety in health care 5. Ambulance Victoria, Annual report 2008 –2009. http://www.
[14, 38, 41, 52, 53]. Facilities should have in place standard ambulance.vic.gov.au/annualreport0809/Downloads.htm (18
protocols to guide those involved in non-emergency patient February 2010, date last accessed).
transport (Fig. 3). Examples of such protocols are available 6. Scottish Ambulance Service, Annual Report and Accounts
[54], but appear to be few and far between. 2008/2009. http://www.scottishambulance.com/userfiles/file/
Interestingly, only two studies mentioned the use of infor- Publications/Annual_Report2008-09.pdf (18 February 2010,
mation and communication technologies to aid the transport date last accessed).
process [26, 30]. This technology can be used to standardize 7. Bellingan G, Olivier T, Batson S et al. Comparison of a special-
practice and improve communication, efficiency and appro- ist retrieval team with current United Kingdom practice for the
priateness of care through, for example, allowing services to transport of critically ill patients. Intensive Care Med
be booked online, and information to be protocol-driven 2000;26:740 –4.
and conveyed immediately, thus improving efficiency, stan- 8. Flabouris A. Patient referral and transportation to a regional
dardization and completeness of information, as has been tertiary ICU: patient demographics, severity of illness and
found with other hospital services utilizing such a technology outcome comparison with non-transported patients. Anaesth
[55 – 59]. Intensive Care 1999;27:385– 90.

73
Hains et al.

9. Orr RA, Felmet KA, Han Y et al. Pediatric specialized transport 26. Geehr EC, Norton BA, Whitman P et al. Financial and oper-
teams are associated with improved outcomes. Pediatrics ational impact of a transfer center. Qual Assur Util Rev
2009;124:40–8. 1991;6:127– 31.
10. Cosgrove JF, Snowden CP, Roy AI et al. Record keeping during 27. Hickey EC, Savage AM. Improving the quality of inter-hospital
transfer of critically ill patients—room for improvement? Care transfers. J Qual Assur 1991;13:16 –20.
Critically Ill 2001;17:88 –93.
28. Alraqi S, Coughlan R. Transfer delay audit. Ir Med J 2007;100.
11. Dryden CM, Morton NS. A survey of interhospital transport of
29. Etxebarria MJ, Serrano S, Ruiz Ribo D et al. Prospective appli-
the critically ill child in the United Kingdom. Paediatr Anaesth
cation of risk scores in the interhospital transport of patients.
1995;5:157– 60.
Eur J Emerg Med 1998;5:13–7.
12. Reeve WG, Runcie CJ, Reidy J et al. Current practice in transfer-
30. Wasserfallen JB, Meylan N, Schaller MD et al. Impact of an
ring critically ill patients among hospitals in the west of
intervention to control risk associated with patient transfer.
Scotland. Br Med J 1990;300:85–7.
Swiss Med Wkly 2008;138:211 –8.
13. NSW Department of Health, Transport for Health
31. Antwi C, Flynn A, Chrichard P et al. Transferring people with
Policy 2006 –2011. http://www.health.nsw.gov.au/policies/pd/
mental illness from emergency department to acute mental
2006/pdf/PD2006_068.pdf (2 December 2009, date last
health wards: survey of contemporary practice. Psychiatr Bull R
accessed).
Coll Psychiatr 2006;30:447– 9.
14. Deasy C, O’Sullivan I. Transfer of patients—from the spoke to
32. Craig SS. Challenges in arranging interhospital transfers from a
the hub. Ir Med J 2007;100:538–9.
small regional hospital: an observational study. Emerg Med
15. Metropolitan Ambulance Services. 2007–2008 annual report. Australas 2005;17:124–31.
http://www.ambulance.vic.gov.au/media/docs/Annual-Report-
33. Deane SA, Gaudry PL, Woods WP et al. Interhospital transfer
2007-2008-d79e482a-2c2c-4131-9c33-804eb00cd70f-0.pdf (11
in the management of acute trauma. Aust N Z J Surg
November 2009, date last accessed).
1990;60:441 –6.
16. State of NSW through the Special Commission of Inquiry.
34. Lee A, Lum ME, Beehan SJ et al. Interhospital transfers:
Final report of the special commission of inquiry: acute care in

Downloaded from by guest on March 22, 2016


decision-making in critical care areas. Crit Care Med
NSW Public Hospitals. http://www.lawlink.nsw.gov.au/
1996;24:618 –22.
acsinquiry (11 November 2009, date last accessed).
35. Crandon IW, Harding HE, Williams EW et al. Inter-hospital
17. Huggins C, Shugg D. Non-emergency patient transport in
transfer of trauma patients in a developing country: a prospec-
Victoria: An overview. J Emerg Prim Health Care 2008;6.
tive descriptive study. Int J Surg 2008;6:387– 91.
18. Monik LA. Reducing patient transportation costs. Healthc Q
36. World Health Organisation. Global priorities for patient safety
Online Case Study 2005;1 –4.
research. http://whqlibdoc.who.int/publications/2009/9789241
19. Department of Health. Our health, our care, our say: a new 598620_eng.pdf (10 November 2009, date last accessed).
direction for community services. http://www.dh.gov.uk/en/
37. Beach C, Croskerry P, Shapiro M. Profiles in patient safety:
Publicationsandstatistics/Publications/PublicationsPolicyAnd
emergency care transitions. Acad Emerg Med 2003;10:364– 7.
Guidance/DH_4127453 (2 December 2009, date last
accessed). 38. Ye K, Taylor DM, Knott JC et al. Handover in the emergency
department: deficiencies and adverse effects. Emerg Med
20. Department of Health. Eligibility criteria for patient transport
Australas 2007;19:433–41.
services (PTS). http://www.dh.gov.uk/en/Publicationsand
statistics/Publications/PublicationsPolicyAndGuidance/DH_07 39. Australian Commission on Safety and Quality in
8373 (2 December 2009, date last accessed). Healthcare. Windows into safety and quality in healthcare. http:
//www.safetyandquality.gov.au/internet/safety/publishing.nsf/
21. Western Australia Country Health Service. Improving clinical
Content/windows-into-safety-and-quality-in-health-care-2008
handover in inter-hospital patient transfers—public report on
(17 December 2009, date last accessed).
pilot study. http://www.safetyandquality.gov.au/internet/safety/
publishing.nsf/content/com-pubs_CH-IHPT/$File/WACHS- 40. Boockvar KS, Burack OR. Organizational relationships between
PubReport.pdf (2 December 2009, date last accessed). nursing homes and hospitals and quality of care during hospi-
tal-nursing home patient transfers. J Am Geriatr Soc
22. Toronto Emergency Medical Services. Non-emergency trans-
2007;55:1078 –84.
fers. http://www.torontoems.ca/main-site/service/non-emerg.
html (accessed). 41. Solet DJ, Norvell JM, Rutan GH et al. Lost in translation: chal-
lenges and opportunities in physician-to-physician communi-
23. Donabedian A. The quality of care. how can it be assessed?
cation during patient handoffs. Acad Med 2005;80:1094 –9.
JAMA 1988;260:1743 –8.
42. Stolte E, Iwanow R, Hall C. Capacity-related interfacility patient
24. Ammon AA, Fath JJ, Brautigan M et al. Transferring patients to
transports: patients affected, wait times involved and associated
a pediatric trauma center: the transferring hospital’s perspective.
morbidity. CJEM 2006;8:262 –8.
Pediatr Emerg Care 2000;16:332 –4.
43. Belway D, Dodek PM, Keenan SP et al. The role of transport
25. Casey MM, Wakefield M, Coburn AF et al. Prioritizing patient
intervals in outcomes for critically ill patients who are trans-
safety interventions in small and rural hospitals. Jt Comm J Qual
ferred to referral centers. J Crit Care 2008;23:287–94.
Patient Saf 2006;32:693 –702.

74
Patient transport services

44. Camasso-Richardson K, Wilde JA, Petrack EM. Medically 53. Bowles EJA, Tuzzio L, Wiese CJ et al. Understanding high-
unnecessary pediatric ambulance transports: a medical taxi quality cancer care: a summary of expert perspectives. Cancer
service?. Acad Emerg Med 1997;4:1137 –41. 2008;112:934–42.
45. Limprayoon K, Sonjaipanich S, Susiva C. Transportation of cri- 54. Victorian Government Department of Human Services.
tically ill patient to pediatric intensive care unit, Siriraj Hospital. Non-emergency patient transport. Clinical practice protocols.
J Med Assoc Thai 2005;88 Suppl 8:S86 –91. www.health.vic.gov.au/nept (17 December 2009, date last
accessed).
46. Mackenzie PA, Smith EA, Wallace PG. Transfer of adults
between intensive care units in the United Kingdom: postal 55. Nam HS, Han SW, Ahn SH et al. Improved time
survey. Br Med J 1997;314:1455 –6. intervals by implementation of computerized physician order
entry-based stroke team approach. Cerebrovasc Dis
47. Australasian College for Emergency Medicine, Joint Faculty of
2007;23:289 –93.
Intensive Care Medicine and Australian and New Zealand
College of Anaesthetists. Minimum standards for transport of 56. Kripalani S, LeFevre F, Phillips CO et al. Deficits in communi-
critically ill patients. Emerg Med 2003;15:197– 201. cation and information transfer between hospital-based and
primary care physicians: implications for patient safety and con-
48. The American College of Emergency Physicians. Appropriate
tinuity of care. JAMA 2007;297:831 –41.
interhospital patient transfer. Ann Emerg Med 2009;54:141.
57. Georgiou A, Morse W, Timmins W et al. The Use of Performance
49. Warren J, Fromm REJ, Orr RA et al. Guidelines for the inter-
Metrics to Monitor the Impact of CPOE on Pathology Laboratory
and intrahospital transport of critically ill patients. Crit Care Med
Services. In: Studies in Health Technology and Informatics.
2004;32:256 –62.
Amsterdam, IOS Press, 2008;136:291 –6.
50. Shirley PJ, Hearns S. Retrieval medicine: a review and guide for
58. Georgiou A, Westbrook J, Braithwaite J et al. Multiple per-
UK practitioners. Part 1: Clinical guidelines and evidence base.
spectives on the impact of electronic ordering on hospital
Emerg Med J 2006;23:937 –42.
organisational and communication processes. HIM J
51. Whitelaw AS, Hsu R, Corfield AR et al. Establishing a rural 2006;34:130 –5.
emergency medical retrieval service. Emerg Med J 2006;23:76–8.
59. Westbrook JI, Georgiou A, Dimos A et al. Computerised path-
ology test order entry reduces laboratory turnaround times and

Downloaded from by guest on March 22, 2016


52. Ligtenberg JJ, Arnold LG, Stienstra Y et al. Quality of interhos-
pital transport of critically ill patients: a prospective audit. Crit influences tests ordered by hospital clinicians: a controlled
Care 2005;9:R446– 51. before and after study. J Clin Pathol 2006;59:533 –6.

75