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.