Study On The Risk Factors Of Oxygen Desaturation Decrease During Intra-hospital Transport Of Intensive Care Unit Patients In Emergency Department And Application Of Standardized Hierarchical Transport Model

Objective:1.To describe the current status of intensive care unit（ICU）patients in emergency department occurred oxygen saturation（SpO₂）decrease during intrahospital transportation（IHT）,and explore risk factors of oxygen saturation（SpO₂）decrease during IHT of intensive care unit patients in emergency department.2.According to the risk factors of oxygen saturation（SpO₂）decrease during IHT of ICU patients in emergency department,combined with the domestic and foreign research,Standardized hierarchical transport model were implemented to transport ICU patients in emergency department and investigate the impact of the implementation of this program on patient’s SpO₂.Methods:The first part is descriptive study:A cross-sectional study design was adopted,from April to May,2017,we investigated 182 ICU patients who required IHT in an emergency department in a tertiary hospital in Shanxi Province by using self-designed Evaluation Form of Intrahospital Transportation for ICU Patients in Emergency Department.The data were analyzed by SPSS 19.0.We divided patients into two groups based on whether their SpO₂ decreased or not.Risk factors of SpO₂ decrease were identified by univariate and multivariate Logistic regression analysis.The second part is Quasi-experimental study:Select 2017 September to October,a total of 68 patients who required intrahospital transportation in a Shanxi provincial 3A grade hospital emergency department as the research object.34 patients who required IHT in September 2017 were included as control group in chronological order,and 34 patients in October 2017 were treated as intervention group.In the control group,the patients were transported by the routine transportation method,and the intervention group used the Consensus on Hospital Transfer in Emergency Critical Patients--Standardized Hierarchical Transport Scheme（hereinafter referred to as the standardized hierarchical transport scheme）to transport the patients.Using self-designed Evaluation Form of Intrahospital Transportation for ICU Patients in Emergency Room to investigate and collect data.The data were analyzed by SPSS19.0.The t-test was used to compare the indexes before and after the intervention.The incidence of SpO₂ decrease was compared using the chi-square test and evaluate the effect of standardized hierarchical transport scheme on patient’s SpO₂during intrahospital transportation.Results:1.Comparison of patient’s oxygen saturation at different time points:SpO₂ of 182patients before transport was（98.3±0.9）%,5 min and 10 min measured values respectively were（93.1±3.5）%and（91.5±4.2）%.The oxygen saturation of the patients when it reaches the destination is（90.6±4.7）%.The transit time of the measurement results at various time points using repeated measures analysis of variance,result as different time points in patients with different SpO₂,the difference was statistically significant（F=163967.38,P<0.001）.2.Univariate analysis of SpO₂ decrease in intensive care unit（ICU）patients during intrahospital transportation:Among 182 patients,117 had SpO₂ decrease,and the rate of SpO₂ decrease was 64.3%,and 65 patients not occur SpO₂ decrease.Univariate analysis showed that there were significant differences in age,MEWS score,disease type,transit time,transit escort staff and oxygen supply device,the difference was statistically significant（P<0.05）.3.Logistic regression analysis of SpO₂ decrease in intensive care unit（ICU）patients during intrahospital transportation:Multivariate Logistic regression analysis was performed on variables that were significant in univariate analysis.The results showed that the age,MEWS score,type of disease,delivery escort,and oxygen supply were the risk factors for the decrease of SpO₂ during intrahospital transportation in emergency ICU patients.4.Effect of standardized hierarchical transport scheme intervention:After standardized hierarchical transport scheme intervention,intervention group patients SpO₂ decrease significantly lower than the incidence of the control group,the difference was statistically significant（P<0.05）.Moreover,the difference in transit times between the two groups before and after intervention was statistically significant（P<0.05）.Conclusion:1.The incidence of SpO₂ decrease during intrahospital transportation of intensive care unit（ICU）patients in emergency department is higher.SpO₂ decrease is the result of combination of multiple risk factors during IHT.We ought to enhance training of escort personnel,assess patient’s condition and SpO₂ level accurately and make plan before transportation,choose qualified oxygen supply device to ensure patients can have effective oxygen supply during IHT,which prevent SpO₂ decrease during IHT.2.The application of standardized hierarchical transport scheme can effectively reduce the incidence of SpO₂ decrease during intrahospital transportation in emergency department ICU patients.In addition,it can effectively shorten the transit time.