Safe movement of a critically ill patient requires the coordinated effort of numerous trained individuals. Often the patient, monitors, and infusion pumps must be changed several times during one movement. Poorly designed or antiquated systems may even require the disconnection of medications and monitors and reconnection to completely different infusion systems and monitoring systems even within the same hospital, increasing transport time as well as subjecting the patient to periods without observation of vital signs or infusion of vital drugs. Systems that are not efficient, compact, and uncluttered can harm patients. Current work is being done on mobile ICU models that have integrated monitoring and support systems including ventilators, defibrillators, suction, point-of-care blood chemistry analysis, invasive monitoring of blood pressures, pulse oximetry, temperature, oxygen flow, and ECG. The benefits of such compact, contained systems include the need for fewer transport personnel, shorter preparation time, reduced periods of manual ventilation, and the potential to provide continuity of care and monitoring from the site of injury, transport to the hospital, emergency department admission, studies and transport to the ICU.98,99 Not only must equipment be compact and standardized for transport, ideally it should be compatible among and between the emergency department, operating room, intensive care unit, and common sites of patient treatment (eg, cardiac catheterization, radiology). It is recognized that a system of universal compatibility among different hospitals may be too costly and difficult, but within a single transport system and hospital it is not only feasible but should be imperative.
The Cleveland Clinic Foundation and the Massachusetts General Hospital have established systems that allow the easy transfer of support equipment without interruptions in therapy or the flow of vital information.1 The same monitors and infusion pumps used in the operating room are used during transfer and upon arrival in the ICU. Transport monitoring merely becomes an extension of the familiar bedside monitor. The benefits seen include more rapid preparation of the patient for movement, fewer personnel needed for transfer, and improved patient care.100
A multidisciplinary approach to ICU, operating room, and transport is imperative when hospitals upgrade their systems. Representatives from critical care, anesthesiology, surgery, respiratory therapy, nursing, and administration have vested stakes in safe, efficient patient movement.