SPECTRE Blog Series Part 4: Special Pathogen Intra and Inter-facility Patient Transport

When patients infected with high-consequence pathogens need to be moved within a hospital or transferred between different healthcare facilities, continuity of care, patient safety, and environmental safety is crucial. Careful planning of intrahospital and interhospital transports plays a critical role in better patient outcomes by ensuring that a patient receives the care they need in a time-efficient and safe manner. In this blog, we will dive into the importance of intrahospital and interhospital patient transport and discuss best practices when it comes to the preparedness of the sending facility, transport team, and receiving facility.

Intra and Inter-facility Patient Transport:

The primary goal of intra- or inter-facility patient transfers is to ensure optimal health by transferring patients with special pathogens to the nearest facility that can provide the required specialized care in a setting that keeps the healthcare personnel and community safe. The sending and receiving facilities should prioritize the continuity of medical care for the patient while preventing exposure to healthcare personnel and the general public. The following information serves as a guide for the planning and execution of patient handoff between healthcare personnel and transport teams in the event of special pathogen intra- and inter-facility patient transport.

What is intra-facility patient transport and when is it needed?

• Intra-facility patient transport refers to the movement of patients within a single healthcare facility.
• It is often required for patients who need diagnostic imaging and various medical procedures that can not be completed within their room.
• May also be necessary when, for instance, a person who initially received care in the emergency department and has already been admitted to a regular patient room within the hospital is later determined to be a high-consequence infectious disease (HCID) patient during their hospital stay. They may require intra-facility patient transport to an isolation room or specialized biocontainment unit in such cases.

What is interhospital patient transport and when is it needed?

• Inter-facility patient transport involves moving patients between different healthcare facilities.
• It allows facilities to transfer patients needing specialized care that cannot be adequately performed at their current facility.

Mobilizing for patient transport

        -        Deciding to transport

• The decision to transport a patient is crucial as transport involves additional risks and expenses for both the patient and the healthcare staff. 
• Establish a communications plan that identifies all points of contact and distribute it to all parties to facilitate communication. This will include complete information about the patient’s clinical condition, ongoing treatment, reasons for transport, mode of transport, and the timeline shared in a written document.
• Notify responsible parties, including the sending facility, receiving facility, transport team, and public health officials.
• Consider the need for additional security during transportation and at the sending and receiving facility
• Maintain communication with local, county, state public safety, and law enforcement personnel during transport.
• Special considerations include media discipline and county and state regulations and needed permissions.

  -          Pre-transport stabilization and preparation

• Before the transport, it is important to properly prepare and stabilize the patient to prevent any adverse events or deterioration in their clinical condition. This includes assessing the patient’s airway, breathing, circulation, and neurological status.
• Confirm that the transport team and receiving facility personnel have appropriate personal protective equipment (PPE) ensembles (they may be different depending on mission requirements and patient condition).
• Have a communication plan in place to give real-time updates
• Confirm and communicate with the designated point of contact at each facility the exact location for patient handoff – this location should be pre-determined by facilities and chosen to minimize media presence and environmental exposure at the facility, and prevent exposure of unprotected staff, patients, and visitors.
• Determine the need for additional security such as state public safety and law enforcement personnel in case roads need to be closed to ensure the route of travel is secure.

  -          Choosing mode of transport

• Ground
• Air transport
• Air medical transport is advantageous for patients in time-sensitive situations, but additional communications and approvals are required

Preparing for transfer of patient and patient care

           -          Sending facility:

• Maintain appropriate infection control measures while interacting with and preparing the patient for transport.
• Identify the EMS providers who have received proper training and will accompany the patient during the transfer.
• Consider providing the patient with anti-nausea medicine to reduce the risk of vomiting.
• Prepare to communicate with the transport agency directly to provide up-to-date patient status and facilitate patient transfer.
• Obtain vital signs immediately before the transfer of care to share with the transport team.
• Consider placing the patient in barrier garments to limit exposure to the transport team or vehicle. This can include an impermeable suit, surgical mask, gloves, impervious sheets, and adult undergarments, as needed.
• Communicate the transport plan to family and friends of the patient, as appropriate.
• Provide medical history and information to receiving facility.

             -          Transport personnel

• [Before transport]
•  Confirm that the receiving facility is ready for patient arrival.
• Confirm the patient’s condition and the number of personnel required to accompany the patient during transfer.
• Confirm that all agencies involved in patient transport have access to secure communications.
• Ensure procedures have been implemented to limit contamination of ambulance environmental surfaces (isolation of driver compartment, draping, etc.). SPECTRE Blog Series Part 2: EMS Biosafety Transport for Special Pathogens: A Guide to Implementing the Hierarchy of Controls Framework
• Ensure adequate inventory of supplies such as appropriately fitted PPE for the personnel who are assigned to the transport mission and supplies for decontamination and disinfection (e.g., U.S. EPA-registered hospital disinfectant, and “spill kit”, etc.)
• Supplies for waste collection – biohazard bags, autoclave bags
• Hold mission briefing for the transport team to review

• [During transport]
  • Observe the donning of PPE and when ready, proceed to make patient contact (only the minimum number of providers necessary to manage the patient should be present).
  • Conduct a brief patient assessment to determine the patient’s stability, “dry” or “wet” symptoms, and need for intervention before and during patient transport.
  • Any documents provided by the sending facility should be free of contamination. Consider them contaminated and package them as appropriate for transport by ambulance personnel.
  • Report the patient’s condition and ETA to the receiving facility to facilitate their readiness to receive the patient from the transport agency immediately upon arrival.
• [After transport]
  • Transfer patient care to the receiving facility team as arranged.
  • Proceed with ambulance decontamination/disinfection and waste management measures as planned.
  • Ambulance transport personnel doff PPE under the supervision of qualified monitors.
  • Secure mission, debrief providers, and initiate post-mission surveillance as indicated.

    -          Receiving facility

• Ensure the isolation room is ready to receive the patient.
• Prepare arrival site and route of entry to isolation room (via the most direct route) .
• Communicate with ambulance transport agency regarding readiness to receive patient, route of entry, and location of patient transfer.
• Inform appropriate public health, emergency management, and public safety authorities on the patient’s arrival.
• Communicate any diagnostic test results to the transporting team as appropriate to inform the need for continuing post-mission surveillance of ambulance providers (EMTs, paramedics, etc.).

Klarissa is a 2^nd year Master of Public Health – Bioethics graduate student at the University of Texas Medical Branch School of Public and Population Health. She is also a Research Associate in the Neurology Lab on campus studying Alzheimer’s Disease and plans to go to medical school after completing her MPH. In her free time, she enjoys being outdoors, singing and playing the guitar and violin.

Resources:

https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201509-587PS

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7121884/

https://epiguard.com/patient-transport-101-intrahospital-interhospital-transport/

https://www.cdc.gov/vhf/ebola/pdf/patient-handoff.pdf

https://www.miemss.org/home/Portals/0/Docs/Guidelines_Protocols/Interhospital-Transfer-Manual-20211216.pdf?ver=ZW7MueL85djBnKgb3m_aQw%3D%3D