The Incidence of Adverse Events Associated with Physiological Changes during the Transfer of Patients in Intensive Care Units

Most critically ill patients admitted to intensive care units need to be transferred to perform diagnostic and therapeutic procedures. This transfer can be associated with adverse events such as disorders of various cardiovascular systems, respiration and nerves. The purpose of this study was to determine the incidence of adverse events related to physiological changes during transfer from Intensive Care Units (ICU) in Jahrom Pimanyani Hospital, Jahrom, Iran.

In this descriptive cross-sectional study, data on patient transfers from the ICU of a university hospital were collected from 9 February 2019 to 10 August 2019. Descriptive and analytical statistics indices were analyzed by SPSS software 22.

Out of 588 cases of transfer, 536 patients (91.2%) had adverse events. Actually, 351 (65.5%) of the adverse events were related to physiological changes in the body. The most common adverse events in cardiovascular, respiratory, gastrointestinal, and endocrine systems included an increase of heart rate(≥ 20)  by 15.9%, a 5% decrease in SPO2 for more than one minute by 32.5%, agitation by 15.1%; vomiting by 15.1% and hypoglycemia by 0.2%.  The most common adverse event was increased pain by 11.4%. The results of chi-square test showed that there was a significant relationship between gender and the incidence of adverse events (p-value = 0.035).

The results showed that the incidence of adverse events during the transfer is high, which can be due to lack of equipment needed during the transfer, illness of patients and also human errors due to inadequate training of the transfer team. It is recommended to help reduce the incidence of adverse events by standardizing the equipment needed during the transfer as well as giving necessary training to the transfer team. The existence of numerous and serious physiological deficiencies of patients in need of special care is indicative of numerous managerial and organizational problems that are in conflict with the safety of patients at risk.