Strategic changes to improve intrahospital transport monitoring

Executive summary

Every day, patients—whether critically ill or not—are transported across departments for imaging, interventions, or surgery. During these transitions, risks escalate. Patient morbidities combined with equipment failure, clinical oversight, and poor monitoring integration can cause avoidable adverse events, some with life-threatening consequences³. 

For example, researchers have noted that when moving patients from the emergency department, these “unwanted or unexpected events, mainly happen during the transportation of patients for diagnostic imaging or invasive procedures and result in a wide spectrum of issues from vital and mental condition changes to cardiopulmonary arrest and death⁷.” Adverse event incidence during intrahospital transport has been shown to approach 68% in some studies, with 4 to 9% of patients requiring medical intervention⁸.

As Fanara et al. point out, transport impacts these patients via two mechanisms³. The first is the actual movement of the patient during transport, including acceleration and deceleration, changes in posture, and transfer between surfaces, all of which may affect the patient at hemodynamic, respiratory, neurological, psychological, and algesic levels. Additionally, the environmental changes the patient experiences during transport from the protection of the initial care unit, may increase physiological stress. These include issues such as equipment changes, noise, the hardness of the examining table and the procedure itself. 

In response to these risks, intensive care and emergency medicine colleges and societies have developed recommendations for the safe practice of intrahospital transport. However, multiple studies, such as the research conducted by Lahner and Papson, which delved into the rates of serious adverse events, have concluded that the risks remain real³.

In this article, we'll take a deep dive into the risks and gaps in transport, as well as discuss the functionalities you should look for in a monitoring solution to support a great level of patient safety. Additionally, we'll discuss how choosing a purpose-built transport monitoring platform, helps not only to integrate monitoring across care areas, but also eliminate data loss, and support healthcare providers with a robust and intuitive solution.

When movement becomes a moment of risk

Even short trips through the hospital can be clinically hazardous. From the emergency department (ED) to the intensive care unit (ICU), or the operating room (OR) to radiology, patient handoffs during intrahospital transport (IHT) are points of vulnerability—especially when monitoring and equipment fall short.

The pooled results of 24 studies showed that up to 26.2% of IHTs involve an adverse event (AE), including cardiovascular instability, hypothermia, or equipment-related failures¹. These studies included transport of adults aged 16 years or older classified as critically ill, defined as patients admitted to an ICU. Intrahospital transports occurred during an ICU stay or to the ICU from other units, including the emergency room, operating room, and general ward.

Additionally, research by Beckmann's identified serious AEs in 31% of cases including four deaths out of 191 IHTs when investigating equipment- and organization-related AEs³.

However, progress can be made. In fact, in looking at the results of individual studies, the key role that implementation of appropriate protocols plays becomes evident.

A study of 207 patients with the mean age of 58.9 ± 20.6 years found that 33.3% of the patients were affected by adverse events during transport. The occurrence of adverse events decreased to 10.8% once a transport protocol was implemented⁴. This protocol included a training process, performed by a senior emergency medicine resident with the assistance of a skilled nurse in a 4-hour session. Training focused on transfer safety guidelines and required skills courses, re-evaluating the equipment before doing the transfer and basic life support (BLS). 

A vital part of improving transport protocols as pointed out by Fanara et al. is that “equipment must be adapted for transport purposes and facilitate a continuum of care and monitoring during IHT³.”

In “Checklist for a safe intra-hospital transport of critically ill patients: A scoping review”, Canellas et al. concurs stating that by “standardizing the monitoring equipment and the conducted actions, it is possible to avoid and/or minimize the occurrence of adverse events, to achieve excellence in care provision, and to increase patient safety⁵.”

The researchers concluded that due to the inherent peril of critically ill patients, “For the duration of the IHT, the levels of care, surveillance, and intervention, should be equal to, or higher than, those observed in the service of origin⁵.”

The risks are real: equipment-related failures during intra hospital transport

Even well-staffed teams with protocols in place face equipment challenges. These challenges can include everything from power failures in portable monitors to ECG lead failures and alarm disconnections. Additional challenges that must be recognized include intra venous line or medication pump failures, ventilator disconnects during movement and delayed recognition of patient deterioration.

Such incidents can occur in any patient population; they’re especially common in perioperative, emergency, and diagnostic transport scenarios where clinical teams are often overburdened.

For example, Fanara et al. states, “AE incidence increased considerably (particularly AEs relating to clinical instability) when transport was carried out in emergency conditions as opposed to being pre-arranged (7.8% versus 2.4% respectively, P < 0.05)³.”

Yet, researchers have concluded that, “The development of adapted equipment and the widespread use of check-lists and proper training programs would increase the safety of IHT and reduce the risks in the long-term³.”

Of utmost importance to note is that research has concluded that, many times, adverse events occurring during IHT are only detected at the destination service, and not when they occur (during transport)⁵.

Therefore, healthcare systems must take a close look at the equipment used for patient monitoring during transport. To ensure basic safety levels, questions to ask should center on important themes: ease of use, hospital-wide monitoring and clinical excellence, including:

• Are they compatible with the existing monitoring solution?
• Are they easy to use?
• Does the transport monitor have good signal quality that can be trusted by the clinician to guide decision making?
• Are they robust, capable of withstanding the rigors of transport, such as mishandling and falls which are all too common
• Do our transport monitors provide continuous, high-fidelity data throughout the journey?
• Are they easy to reconnect at the destination?

For hospitals seeking to provide more advanced, state-of-the art care level, clinical excellence must still take center stage, while also supporting collaborative care and operational versatility. Additional questions to ask include:

• Do the monitors we use communicate with other hospital systems during transport, such as the EMR or central stations?
• Do they allow clinicians to easily add and subtract parameters to meet patient monitoring needs, such as CO2 monitoring?
• Do they provide alarm configurations to meet the needs of hospital policies and patients?
• Are there additional specialized parameters to consider?

What the guidelines say—and where they fall short

There are well-defined guidelines for ICU patient transport (e.g., AAGBI, APSF, ANZCA, ICS, SFAR). Yet despite current recommendations, adverse events still occur. Because of this, hospitals must take their own steps to minimize risk and maximize continuity of care.

The first step to address care gaps includes utilizing continuous monitoring with BP, ECG, SpO₂, and access to transport defibrillator. Secondly, it’s important to ensure destination readiness, including suction, power, oxygen, and “crash cart” access. Personnel must also be considered with anesthesiology or advanced-trained staff for critical moves. Finally, alarm sensitivity, specificity and visibility in high-noise environments must be considered.

Still, most guidelines don’t address the integration gaps between bedside and transport monitoring, nor the usability for staff with various training levels. Because of this, healthcare systems seeking to uphold excellence in care should look to recommendations by researchers such as Fanara et al. to utilize transport adapted equipment to better support patient safety. Put simply, a purpose-built transport monitoring platform provides vital support, complete data continuity and full flexibility across multiple care areas.

The case for transport-ready monitoring: care without compromise

To minimize adverse events and provide a high level of care to their patients, modern hospitals require transport monitoring that integrates seamlessly, supports clinical workflows, and reduces event risk. 

Guidelines for IHT transport monitoring differs from societies. However, there is a general agreement that it should include ECG, pulse oximetry, non-invasive blood pressure, respiratory rate, and, if ventilated, capnography ^6,9.

Therefore, must-have monitor capabilities for transport for clinical safety include continuous real-time monitoring with ECG, SpO₂, and BP and alarm accuracy even in noisy environments.

Additional monitoring capabilities to improve intrahospital transport for state-of-the-art healthcare systems include:

• True continuity of care: vital signs are captured during transport and communicated continuously to the Electronic Medical Record and alarms transferred to central monitoring during transport
• A monitoring solution for many locations: designed to dock and undock easily from multiple hosts (ED, ICU, OR, PACU, etc.).
• Unified interface: staff use the same user interface across locations—no retraining, no confusion.
• Scale up and down based on patient acuity: from basic vitals to advanced cardiac monitoring (ST/QT analysis, capnography, multi-lead ECG).The transport monitor configuration chosen at initial purchase should not limit the potential of upgrading ‘on the spot’ with additional parameters.
• Robust and durable: lightweight, impact-resistant, and built for long battery life.
• Smart alarms: reduces false alerts while ensuring prompt attention to real deterioration.  
• Customizable configurations: aligns with transport protocols for both low- and high-risk patients.

For more advanced hospital an additional nice to have feature could be:

• Wi-Fi during transport: Wi-Fi-enabled monitoring allows uninterrupted tracking of vital signs and sends near real time data to the EMR and to a central station so that clinicians know their patients' status and they can respond immediately steps to any deterioration during transport (for example activate faster a red code). Consistent and reliable Wi-Fi technology support therefore advanced hospital protocols.

Practical benefits: why it matters for your teams and your bottom line

Utilizing transport-ready monitors that offer hospital -wide level solutions, supports clinical staff by reducing training burden and by simplifying  their work. 

It also improves responsiveness through fidelity acquisition and high-visibility alarms and helps maintain patient stability during every leg of the journey.

Hospitals can improve patient safety metrics by reducing the risk of sentinel events during intrahospital transport of critically ill patients^1.  Additional benefits include enhanced interoperability across departments and care areas and support for compliance and audit-readiness with seamless data capture.

Closing thoughts

Intrahospital transport will never be risk-free—but your monitoring solution can make it much safer. As patient acuity shifts and pressure on staff grows, C-suite decision-makers have a rare opportunity: to rethink the silent gaps in patient movement by utilizing monitoring platforms built for continuity, data integrity, and clinical ease. 

By focusing on values that include ease of use, enterprise monitoring, collaborative care, operational versatility and clinical excellence, leaders can choose a transport-ready monitor that retains the same intuitive user experience across the hospital and offers the visibility and control needed to lead with confidence.

References:

1. Murata M, Nakagawa N, Kawasaki T, et al. Adverse events during intrahospital transport of critically ill patients: A systematic review and meta-analysis. Am J Emerg Med. 2022;52:13-19. doi:10.1016/j.ajem.2021.11.021
2. Peter Williams, Sathappan Karuppiah, Kate Greentree, Jai Darvall, A checklist for intrahospital transport of critically ill patients improves compliance with transportation safety guidelines, Australian Critical Care, Volume 33, Issue 1, 2020, Pages 20-24, ISSN 1036-7314, https://doi.org/10.1016/j.aucc.2019.02.004. (https://www.sciencedirect.com/science/article/pii/S1036731418302315)
3. Fanara, B., Manzon, C., Barbot, O., Desmettre, T., & Capellier, G. (2010, May). Recommendations for the intra-hospital transport of critically ill patients. Critical Care, 14(R87), 3. 10.1186/cc9018
4. Farnoosh L, Hossein-Nejad H, Beigmohammadi MT, Seyed-Hosseini-Davarani SH. Preparation and Implementation of Intrahospital Transfer Protocol for Emergency Department Patients to Decrease Unexpected Events. Adv J Emerg Med. 2018;2(3):e29. Published 2018 Jan 22. doi:10.22114/AJEM.v0i0.50
5. Canellas M, Palma I, Pontífice-Sousa P, Rabiais I. Checklist for a safe intra-hospital transport of critically ill patients: A scoping review. Enferm Glob. 2020;19(60):557-572. doi:10.6018/eglobal.411831
6. Agizew, Tesfaye Belaneh, Ashagrie, Henos Enyew, Kassahun, Habtamu Getinet, Temesgen, Mamaru Mollalign, Evidence-Based Guideline on Critical Patient Transport and Handover to ICU, Anesthesiology Research and Practice, 2021, 6618709, 9 pages, 2021. https://doi.org/10.1155/2021/6618709
7. Salt O, Akpınar M, Sayhan M B, et al. Intrahospital critical patient transport from the emergency department. Archives of Medical Science. 2020;16(2):337-344. doi:10.5114/aoms.2018.79598.
8. Andrew C, Fitzsimons M. Intrahospital patient transport: checklists, adverse events, and other considerations for the anesthesia professional. APSF Newsletter. 2025:24–26.
9. AAGBI and ASA professional documents on critical care transport (latest editions). Intensive Care Society: Guidance on the transfer of the critically ill adult (3rd edition). ANZCA – PG52 Guideline for Transport of Critically Ill Patients (2024/2025). French SRLF, SFAR, and SFMU recommendations on intrahospital transport (Annals of Intensive Care, 2012).