Moving the critically ill patient: intrahospital transport, admission to the ICU and handing over at discharge
- Safe practice
Moving an ICU patient to a scan or to another unit is risky; planning, the right monitors and a clear handover prevent most problems.
What it is
Critically ill patients often leave the ICU for scans or procedures and later move to a ward. Each move is a risk: oxygen saturation can fall, the patient can become agitated, devices can come out, batteries and oxygen can run out, and information can be lost at the handover. French intensive care societies have published recommendations for intrahospital transport that cover the equipment, the monitoring, the preparation of the patient, the team and the organisation. At every transition, a structured handover and medication reconciliation protect the patient.
What it requires
- A manual resuscitation bag with mask and oxygen goes with every patient; it is used only if the ventilator fails.
- Capnography and/or spirometry should detect an accidental extubation at once.
- The cuff pressure of the tracheal tube is checked before and after transport.
- The transport team includes at least one experienced physician and a staff member trained in transport.
- Medication discrepancies affect almost every patient who moves across transitions of care.
How it is applied (and why)
- Confirm the time, the route, the lift and that the destination knows the patient is coming — waiting in corridors adds risk.
- Check the patient: identification wristband, secure lines, a dedicated labelled line for vasoactive drugs — a pulled line during transport is an emergency.
- Prepare pumps with enough drug for the trip and their power cables, and plug them in again on arrival — the drug must not run out on the way.
- Check the monitor, the ventilator alarms, suction, intubation kit, defibrillator and oxygen reserves — everything must last the trip.
- Keep the position, sedation and analgesia the patient needs, and anticipate pain from the move — agitation causes desaturation and dislodged devices.
- Before and after each transfer between beds, check the position of every tube, drain and line — moving the patient moves the devices.
- Record vital signs during transport on a monitoring sheet that goes into the record — it documents what happened.
- On arrival or at discharge, hand over in a structured format, repeat back new orders and reconcile medicines — information lost at transitions harms patients.
- Report every adverse event during transport for analysis — the system learns from incidents.
In nursing practice
- A fall in saturation that needs more oxygen or a change in ventilator settings counts as a high-risk event, and as serious if it is not corrected.
- Avoid hypothermia during transport, above all in children, by monitoring temperature.
- Moving a patient on neuromuscular blockers needs particular caution.
- If the receiving physician cannot monitor the patient, the transport team stays in charge.
Common mistakes
- Leaving with a ventilator or monitor that was not tested on the patient first.
- Taking pumps without enough drug or without power cables.
- Arriving at the scan without having warned the destination.
- A handover without a structure, without repeat-back or without medication reconciliation.
Test yourself
Think of the answer, then tap the question to see it.
What is the minimum monitoring during intrahospital transport of a critically ill patient?
ECG heart rate, pulse oximetry and noninvasive blood pressure; invasive pressure if the patient is unstable or on vasoactive drugs and already has it.
Why is the transport ventilator connected 5–10 minutes before leaving?
To check, while still on wall gas and mains power, that the patient tolerates it and remains stable.
When is the manual resuscitation bag used during transport?
Only if the ventilator fails; it must travel with the patient with a mask, reservoir and oxygen tubing.
Why are medicines reconciled at ICU admission and discharge?
Because medication discrepancies affect almost every patient who moves between care settings.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Intrahospital transport of critically ill patients (excluding newborns): recommendations of the SRLF, SFAR and SFMU (Annals of Intensive Care, 2012); Nursing Fundamentals (Open RN), 2.4 Communicating with Health Care Team Members (Open RN, Wisconsin Technical College System (LibreTexts, CC BY 4.0), 2021); Medication safety in transitions of care (World Health Organization, 2019).
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Representative model, for educational purposes only.