Table 1 Concrete measure of IHT of critically ill patients between control group and observational group

Safety training

Three theoretical lectures, including the “Chinese guidelines for the transport of critically ill patients, 2010” (draft) [12]; maintenance of instruments and equipment related to transfer; emergency programs for sudden cardiac arrest, accidental extubation of artificial airway, failure of transfer ventilator, and insufficient oxygen source; demonstration of cardiopulmonary resuscitation operation and team first-aid during transfer. The nurses were required to work in the ICU for more than 1 year, the doctors needed to work in the ICU for > 6 months, participate in training, and pass the theory test, cardiopulmonary resuscitation test, and inter-hospital transfer simulation test for critically ill patients before they can independently carry out inter-hospital transfer for critically ill patients

① In addition to the traditional training methods, special safety inspection training modules, such as MRI safety instruction, enhanced CT safety instruction, and hyperbaric oxygen safety instruction, were added. ② Training needs attention with respect to the rescue vehicle and the use of drugs, and all the participating personnel is required to pass the examination. ③ Emphasis on the transfer model in the current situation, background, assessment, and recommendations (SBAR) [13]

Safety risks

clustered transfer list

optimizing and improving the clustered transfer list

Administrative staff participation

a special transfer elevator with a built-in telephone extension was set up in Building 1. b. Elevator workers go to work from 8:00 to 18:00

① Increasing transfer elevators (transfer-specific elevators were installed in each building). Eye-catching transfer elevator signs were pasted. Elevator workers wore chest card, and the service attitude was emphasized. ② Adding transfer goods and materials (adding 1 portable invasive ventilator, 2 portable monitors, and 1 transfer bed). ③ Unifying the items, drug types, quantity, and location of the materials in rescue vehicles of the whole hospital to facilitate the use of the second-level first aid site during the rescue. ④ Organizing safe transfer training in the hospital

Communication and cooperation

routine transfer

①Doctors should strengthen communication with the examination department and reduce the waiting time. ② Nurses should focus on health education and psychological nursing to appease the anxiety of the relatives. ③ Arranging for experienced medical technicians to perform the operation. ④ Reports of radiological examination should be obtained within 30 min. ⑤ SBAR model was used when patients were handover to the other departments

Learning from defects

quality control analysis of problems was performed every quarter, implementation of planning, implementation, inspection, adjustment, and improvement (plan, do, check, action, and PDCA) [14]

① Training medical staff to understand the root cause of the condition via lectures. ② Transfer defect analysis of critically ill patients was performed once a month, and simple root cause analysis was used to analyze the defects, including what happened, why, what should be done to reduce the risk, and how to confirm that the risk had been reduced