Effect of planned in-hospital transfer on physiological indicators, level of consciousness, pain, and restlessness in Iran

Background: Intra-hospital transfers of critically ill patients from emergency departments (EDs) to intensive care units (ICUs) carry significant risks, with studies indicating over 60% experience preventable complications. This study evaluated the impact of a structured, planned transfer protocol on patient stability and efficiency compared to routine transfers. Methods: A total of 112 hemodynamically stable adult patients requiring transfer from the ED to ICU at our hospital were enrolled after ethical approval. Participants were randomly assigned to an intervention group (n=56), transferred using a predefined protocol (pre-transfer coordination, equipment checks, dedicated ICU-trained nurse, continuous monitoring), or a control group (n=56) receiving routine care. Physiological parameters (blood pressure, arterial oxygen saturation, heart rate, respiratory rate), transfer time, consciousness (4Score), pain (Nonverbal Pain Scale), and agitation (Richmond Agitation-Sedation Scale [RASS]) were assessed pre- and post-transfer. Data were analyzed using SPSS version 18 with independent t-tests and chi-square test. Results: Groups were comparable at baseline in demographics and clinical parameters. Post-transfer, no significant differences were found in physiological indicators, consciousness levels, or pain scores. However, the intervention group showed significantly lower agitation levels (mean RASS, -2.01 vs. -2.64; P=0.04). Crucially, transfer time was significantly reduced in the intervention group (9.4±2.0 vs.16.0±4.0 minutes, P<0.01, minutes, P<0.01). Conclusions: While planned transfers did not adversely affect physiological stability or consciousness, they significantly reduced patient agitation and halved transfer duration. This demonstrates that structured protocols enhance operational efficiency and may improve the transfer experience. Implementing planned transfer protocols is recommended to optimize intra-hospital patient flow and safety.