Safety of interhospital transport of cardiac patients and the need for medical escorts

Objective:  To review the safety of the current retrieval service procedures and identify factors associated with the need for a medical escort. Methods:  Detailed retrospective chart review of the records of patients with confirmed or presumed cardiac disorders transferred for acute care by the Townsville Hospital Emergency Department retrieval service between June 2003 and December 2004. Results:  A total of 555 charts were reviewed. During transport, 118 complications and 111 interventions occurred. In total, 414 patients required no intervention, 96 required nurse or paramedic care, and 45 needed a medical escort. Only one patient determined to need a doctor was not accompanied by one; however, 183 patients were accompanied by a doctor when no need was identified. A logistic regression model was applied to 463 patients after excluding intubated patients and those with any missing observation data. This found that the following variables were significantly predictive of events during transport requiring a doctor to be present: myocardial infarction (OR 2.48; P  = 0.016; 95% CI 1.2–5.1), having received lysis (OR 3.54; P  = 0.004; 95% CI 1.59–7.92), on an infusion (OR 5.06; P  < 0.001; 95% CI 2.37–10.82) or history of cardiac arrest (OR 7.77; P  < 0.001; 95% CI 2.9–20.77). Conclusion:  Transport of cardiac patients by the Townsville Hospital Emergency Department retrieval service were safely staffed and performed, guided by the expert decision making and clinical support of the clinical coordinators. Patients with a provisional diagnosis at the time of referral of myocardial infarction, a history of receiving lysis or cardiac arrest, or on a drug infusion were more likely to require the expertise of a doctor during transport.