QUIT EMR Trial: a Prospective, Observational, Multicentre Study to Evaluate Quality and 24 hours Post-transport Morbidity of Interhospital Transportation of Critically Ill Patients: Study Protocol

Overview

Journal BMJ Open

Specialty General Medicine

Date 2017 Mar 12

PMID 28283485

Citations 4

Authors

Ulrich Strauch

Dennis C J J Bergmans

Joachim Habers

Jochen Jansen

Bjorn Winkens

Dirk J Veldman

Paul M H J Roekaerts

Stefan K Beckers

Affiliations

Soon will be listed here.

Abstract

Introduction: It is widely accepted that transportation of critically ill patients is high risk. Unfortunately, however, there are currently no evidence-based criteria with which to determine the quality of various interhospital transport systems and their impact on the outcomes for patients. We aim to rectify this by assessing 2 scores which were developed in our hospital in a prospective, observational study. Primarily, we will be examining the Quality of interhospital critical care transportation in the Euregion Meuse-Rhine (QUIT EMR) score, which focuses on the quality of the transport system, and secondarily the SEMROS (Simplified EMR outcome score) which detects changes in the patient's clinical condition in the 24 hours following their transportation.

Methods And Analysis: A web-based application will be used to document around 150 pretransport, intratransport and post-transport items of each patient case.To be included, patients must be at least 18-years of age and should have been supervised by a physician during an interhospital transport which was started in the study region.The quality of the QUIT EMR score will be assessed by comparing 3 predefined levels of transport facilities: the high, medium and low standards. Subsequently, SEMROS will be used to determine the effect of transport quality on the morbidity 24 hours after transportation.It is estimated that there will be roughly 3000 appropriate cases suitable for inclusion in this study per year. Cases shall be collected from 1 April 2015 until 31 December 2017.

Ethics And Dissemination: This trial was approved by the Ethics committees of the university hospitals of Maastricht (Netherlands) and Aachen (Germany). The study results will be published in a peer reviewed journal. Results of this study will determine if a prospective randomised trial involving patients of various categories being randomly assigned to different levels of transportation system shall be conducted.

Trial Registration Number: NTR4937.

Citing Articles

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PMID: 39487145 PMC: 11530535. DOI: 10.1038/s41598-024-70333-6.

The QUality of Interhospital Transportation in the Euregion Meuse-Rhine (QUIT-EMR) score: a cross-validation study.

Strauch U, Florack M, Jansen J, van Bussel B, Beckers S, Habers J BMJ Open. 2021; 11(11):e051100.

PMID: 34799362 PMC: 8606780. DOI: 10.1136/bmjopen-2021-051100.

Differences and Similarities Among COVID-19 Patients Treated in Seven ICUs in Three Countries Within One Region: An Observational Cohort Study.

Mesotten D, Meijs D, van Bussel B, Stessel B, Mehagnoul-Schipper J, Hana A Crit Care Med. 2021; 50(4):595-606.

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[Appropriate allocation of resources for interhospital transfer in emergency medical service-is a physician in the dispatch center helpful?].

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References

Vos G, Nissen A, Nieman F, Meurs M, van Waardenburg D, Ramsay G . Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team. Intensive Care Med. 2003; 30(2):302-308. DOI: 10.1007/s00134-003-2066-7. View

Barratt H, Harrison D, Rowan K, Raine R . Effect of non-clinical inter-hospital critical care unit to unit transfer of critically ill patients: a propensity-matched cohort analysis. Crit Care. 2012; 16(5):R179. PMC: 3682280. DOI: 10.1186/cc11662. View

Singh J, MacDonald R . Pro/con debate: do the benefits of regionalized critical care delivery outweigh the risks of interfacility patient transport?. Crit Care. 2009; 13(4):219. PMC: 2750128. DOI: 10.1186/cc7883. View

Ligtenberg J, Arnold L, Stienstra Y, van der Werf T, Meertens J, Tulleken J . Quality of interhospital transport of critically ill patients: a prospective audit. Crit Care. 2005; 9(4):R446-51. PMC: 1269465. DOI: 10.1186/cc3749. View

Ramnarayan P, Thiru K, Parslow R, Harrison D, Draper E, Rowan K . Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet. 2010; 376(9742):698-704. DOI: 10.1016/S0140-6736(10)61113-0. View

Lahner D, Nikolic A, Marhofer P, Koinig H, Germann P, Weinstabl C . Incidence of complications in intrahospital transport of critically ill patients--experience in an Austrian university hospital. Wien Klin Wochenschr. 2007; 119(13-14):412-6. DOI: 10.1007/s00508-007-0813-4. View

Durairaj L, Will J, Torner J, Doebbeling B . Prognostic factors for mortality following interhospital transfers to the medical intensive care unit of a tertiary referral center. Crit Care Med. 2003; 31(7):1981-6. DOI: 10.1097/01.CCM.0000069730.02769.16. View

Gebremichael M, Borg U, Habashi N, Cottingham C, Cunsolo L, McCunn M . Interhospital transport of the extremely ill patient: the mobile intensive care unit. Crit Care Med. 2000; 28(1):79-85. DOI: 10.1097/00003246-200001000-00013. View

Fan E, MacDonald R, Adhikari N, Scales D, Wax R, Stewart T . Outcomes of interfacility critical care adult patient transport: a systematic review. Crit Care. 2005; 10(1):R6. PMC: 1550794. DOI: 10.1186/cc3924. View

10.

Bellingan G, Olivier T, Batson S, Webb A . Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients. Intensive Care Med. 2000; 26(6):740-4. DOI: 10.1007/s001340051241. View

11.

Belway D, Henderson W, Keenan S, Levy A, Dodek P . Do specialist transport personnel improve hospital outcome in critically ill patients transferred to higher centers? A systematic review. J Crit Care. 2006; 21(1):8-17. DOI: 10.1016/j.jcrc.2005.12.008. View

12.

van Lieshout E, Binnekade J, Reussien E, Dongelmans D, Juffermans N, de Haan R . Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial. Intensive Care Med. 2016; 42(7):1146-54. PMC: 4879164. DOI: 10.1007/s00134-016-4355-y. View

13.

Seymour C, Kahn J, Schwab C, Fuchs B . Adverse events during rotary-wing transport of mechanically ventilated patients: a retrospective cohort study. Crit Care. 2008; 12(3):R71. PMC: 2481462. DOI: 10.1186/cc6909. View

14.

Beckmann U, Gillies D, Berenholtz S, Wu A, Pronovost P . Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med. 2004; 30(8):1579-85. DOI: 10.1007/s00134-004-2177-9. View

15.

Strauch U, Bergmans D, Winkens B, Roekaerts P . Short-term outcomes and mortality after interhospital intensive care transportation: an observational prospective cohort study of 368 consecutive transports with a mobile intensive care unit. BMJ Open. 2015; 5(4):e006801. PMC: 4420937. DOI: 10.1136/bmjopen-2014-006801. View

16.

Warren J, Fromm Jr R, Orr R, Rotello L, Horst H . Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004; 32(1):256-62. DOI: 10.1097/01.CCM.0000104917.39204.0A. View

17.

Uusaro A, Parviainen I, Takala J, Ruokonen E . Safe long-distance interhospital ground transfer of critically ill patients with acute severe unstable respiratory and circulatory failure. Intensive Care Med. 2002; 28(8):1122-5. DOI: 10.1007/s00134-002-1348-9. View

18.

Papson J, Russell K, Taylor D . Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med. 2007; 14(6):574-7. DOI: 10.1197/j.aem.2007.02.034. View

19.

Combes A, Luyt C, Trouillet J, Chastre J, Gibert C . Adverse effect on a referral intensive care unit's performance of accepting patients transferred from another intensive care unit. Crit Care Med. 2005; 33(4):705-10. DOI: 10.1097/01.ccm.0000158518.32730.c5. View

20.

Rosenberg A, Hofer T, Strachan C, Watts C, Hayward R . Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures. Ann Intern Med. 2003; 138(11):882-90. DOI: 10.7326/0003-4819-138-11-200306030-00009. View