Interhospital transport of critically ill and injured patients into the Kenyatta national Hospital

Abstract

Objective - Audit local practices in the transfer of critically ill and injured patients into Kenyatta National Hospital and make recommendations to improve· safety and outcomes during such transfers. Setting - Kenyatta National Hospital Accident and Emergency, pediatric emergency and the Critical Care Unit. Population - Critically ill and injured patients referred from other health facilities during the study period. Methodology - Over two months, teams transporting I J 4 critically iII and injured patients from other hospitals into Kenyatta National Hospital were recruited and interviewed on how they prepared and transported their patients, the level of monitoring, availability of essential equipment and drugs, adverse events during transport and the patients' condition was assessed on arrival at Kenyatta National Hospital. Blood sugar and arterial blood gas analysis were determined for all patients recruited. Results - Most patients transferred during the study period were males (65%) aged between 13 and 40 years (39.5%), referred from district hospitals (59.6%) with surgical illness (54.4%) mainly head injury (27.2%) for advanced care while 32.4% of patients were transferred for non-clinical reasons. /\11 patients were transported using road transport by personnel from the referring hospital who were mostly nurses with inadequate training in critical care but variable levels of experience in transfer of such patients. Doctors and paramedics were involved in the transfer of 15.8 and 14 % of patients respectively. Most patients received (64.9%) had been admitted in medical and surgical wards prior to transfer and there were 10 direct transfers of patients from other intensive care units. Only 34.2% of transport teams communicated with Kenyatta National Hospital before transfer of their patients while attending physicians and surgeons were directly involved in the transfer of 51.8% of the patients. Only 14% of the patients transferred had the recommended level of monitoring during transport and the incidence of adverse events was 61.54%. There were a lot of physiological derangements observed when the patients were examined on arrival at Kenyatta National Hospital with blood pressure, heart rate and temperature changes in 38.6%, 45.6% and 44.7% of the patients respectively. Hypoxia was observed in 26.3% of patients while hyperglycemia and hypoglycemia were seen in 17.5% and 7% of patients respectively. Arterial blood gas analysis was abnormal in 5 I% of patients. Conclusion - Most of the patients were young males with neurosurgical conditions referred for advanced care and had been transferred into Kenyatta National Hospital from district hospitals. The patients were transported by road by personnel from the referring hospitals. Transport teams consisted of mostly of nurses who were inadequately trained in the care of critically ill patients. Patients were poorly prepared before transport and there was poor communication before transfer. There was lack of essential equipment and drugs during transport with suboptimal monitoring and a high incidence of adverse events. Patients had a lot of physiological derangements on arrival at Kenyatta National Hospital.