Development of Guidelines for Monitoring Critically ill Patients to Prevent Deterioration During Intrahospital Transport

Abstract

Introduction: Intrahospital transport of critically ill patients is a process carrying a high risk of acute complications. The development of a systematic practice guideline that aligns with the service unit context is therefore essential.

Research Objectives: To develop and evaluate the use of a critical patient monitoring guideline for preventing clinical deterioration during intrahospital transport at Mahasarakham Hospital.

Research Methodology: This research and development study was conducted across three phases: Phase 1 examined the problem situation from 134 medical records of critically ill patients who underwent intrahospital transport; Phase 2 involved developing the monitoring guideline; and Phase 3 consisted of piloting and evaluating the guideline. The sample comprised three groups: 15 ward heads and professional nurses involved in the guideline development process; 23 professional nurses and staff from the accident and emergency nursing department; and 139 critically ill patients with a Modified Early Warning Score (MEWS) of 4 or above who underwent intrahospital transport, selected through purposive sampling between April and May 2025. Data were analyzed using descriptive statistics and Paired t-test.

Results: Following implementation of the critical patient monitoring guideline, the incidence of unexpected clinical deterioration decreased, with pre-transport deterioration occurring in 2.16% of cases. The mean monitoring competency scores of healthcare providers were significantly higher than before guideline implementation (t = −10.04, p < 0.001). Adherence to the guideline was rated at a high level, and satisfaction with the guideline format was also rated at a high level (Mean = 4.19, SD = 0.65).

Conclusion: The developed guideline offers clear and practical steps suitable for real-world hospital implementation. It strengthened staff confidence and readiness in monitoring clinical changes during transport, reduced the risk of adverse events, and concretely supported the development of nursing service quality in the area of patient safety.

Implications: The guideline should be expanded to all departments, supported by continuous training, long-term outcome monitoring, and the development of an electronic data recording system to sustainably enhance critical patient monitoring efficiency.