The document provides guidelines for best practices in transporting surgical patients from the ward to the operating room and between departments. Guideline I discusses safely transferring patients from the ward bed to a transportation device. Guideline II covers safely transporting patients to the pre-op area or OR. Guideline III addresses transferring patients from the transportation device to the OR table. Guideline IV recommends healthcare organizations establish a coordinated patient transport system for safely moving critically ill patients between departments.

1. 1
Approved October 27, 2006
Revised November 4, 2014
Revised April 14, 2017
AST Guidelines for Best Practices for Patient Transportation
Introduction
The following Guidelines for Best Practices were researched and authored by the AST
Education and Professional Standards Committee, and are AST approved.
AST developed the Guidelines to support healthcare delivery organization’s (HDO)
reinforce best practices in patient transport as related to the role and duties of the
Certified Surgical Technologist (CST®), the credential conferred by the National Board
of Surgical Technology and Surgical Assisting. The purpose of the Guidelines is to
provide information that OR supervisors, risk management, and surgical team members
can use in the development and implementation of policies and procedures for patient
transportation in the surgery department. The Guidelines are presented with the
understanding that it is the responsibility of the HDO to develop, approve, and establish
policies and procedures for the surgery department regarding safe transportation of
patients per HDO protocols.
Rationale
The following are Guidelines for the safe transportation of surgical patients and
recognizing the possible hazards to prevent injuries to the patient and CSTs. The
recommended practices aid in ensuring the transfer and transportation of the patient
without tissue injury; avoiding undue physical or emotional discomfort; and avoiding
severe alterations in body temperature, respirations, and cardiovascular reactions
including hypotension and tissue perfusion.1
The Guidelines include recommendations
for transporting critically ill patients from the source of care (e.g., ICU) to the surgery
department.
Evidence-based Research and Key Terms
The research of articles, letters, nonrandomized trials, and randomized prospective
studies is conducted using the Cochrane Database of Systematic Reviews and
MEDLINE®, the U.S. National Library of Medicine® database of indexed citations and
abstracts to medical and healthcare journal articles.
The key terms used for the research of the Guidelines include: coordinated patient
transport system; critical care; health planning; intrahospital transfer; patient monitoring;
policy making; transporting ICU patients; transporting surgery patients; Universal
Protocol. Key terms used in the Guidelines are italicized and included in the glossary.

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Guideline I
When assigned the transportation of surgical patients it is the responsibility of the
CST to ensure the safe transfer of a patient from a ward bed to a transportation
device.
1. The specific needs of the patient should be considered when selecting the method
of transport. This includes:
A. Need for IV pole(s);
B. Need to transport oxygen tank;
C. Conscious, semi-conscious or unconscious patient;
D. Determining the physical abilities and state of health of the patient.
Knowing the patients state of health and abilities will help in the choice of
mode of transportation, decrease the possibility of accidents to the patient
and CST, and aid in determining the number of HCP needed to help move
the patient from the ward bed to the transporting device.
2. The following parameters should be considered when identifying the mode of
transportation to be utilized to support the safety of the patient and CST.
A. Wheels can be locked.
B. Safety straps available.
C. Side rails are high enough.
D. Ability to use patient transfer devices.
E. Maneuverability of transportation device.
F. Mattress on stretcher is securely held in place.
G. Ability to accommodate positioning needs of the patient.
H. IV poles can be easily transferred with the chosen method of transport.
I. Rails on crib are high enough to prevent pediatric patient from falling out.
J. Method of transport is large enough to accommodate the size of the
patient.
K. Shelf or rack is available to transport oxygen tank and/or monitoring
devices.
L. The transportation device has undergone scheduled inspections,
maintenance and repair to ensure proper functioning.
3. To safeguard the safety of the patient and CST, the following safety measures
should be implemented during the transfer of the patient from the ward bed to the
transport device.
A. There must be an adequate number of HCP available to transfer the
patient. The assessment of the patient will aid in determining the number
of HCP that will be needed.
1) For the conscious, mobile patient a minimum of two HCP
are required.
2) For the semi-conscious or unconscious, non-mobile patient
a minimum of four HCP are required (additional
precautions to be taken for transporting critically ill patients
is addressed in Guideline IV).2
B. To promote the safety of the non-mobile patient and HCP, patient transfer
devices are recommended for use.

3. 3
C. The furniture and equipment in the ward room should be moved as
necessary to ensure adequate space for the safe transfer of the patient to
the transportation device.
D. If using a stretcher, position as close against the patient’s ward bed as
possible and lock the wheels of the stretcher.
E. Confirm the wheels on the patient’s ward bed are locked if wheels are
present.
F. The accessory items should be secured, such as IV lines and drainage
devices before transferring the patient; ensure the lines remain patent and
functioning. If the patient has an indwelling urinary catheter, the bag must
be positioned below the level of the patient to prevent reflux of urine and
must not be placed on the floor.3
4. The following patient care concepts should be carried out during the transfer of
the patient.
A. The CST who is responsible for transporting the patient should introduce
and identify herself/himself to lessen patient anxiety.2
B. The CST must correctly identify the patient’s name and procedure to be
performed to prevent wrong patient and procedure.
1) The CST should approach this much like performing the
“Time Out” procedure in the OR to prevent patient errors;
the patient should state his name that is cross-references to
his/her name band, patient chart and surgery schedule.4
If
the patient is unconscious, the CST should rely on the
patient’s chart to verify the information as well as two
identifiers, the CST and a RN, to confirm the information.5
C. If the patient is conscious, the CST should explain the transfer procedure
prior to executing to reduce the anxiety of the patient and promote safety.2
1) The CST should verbally communicate to the patient that
he/she will indicate that they are ready for the patient to
move over to the stretcher. The CST should instruct the
patient to move slowly to avoid severe physiological
alterations.6
2) The CST should confirm one last time that the wheels on
the ward bed, if present, and stretcher are locked.
3) When the patient is instructed to move from the ward bed
to the stretcher, the CST should lean against the stretcher to
prevent movement and keep against the ward bed.
4) The HCP should maintain the patient’s dignity during the
transfer by keeping him/her covered.2
This will help in
decreasing the patient’s anxiety and ensure their personal
and moral rights.

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Guideline II
It is the responsibility of the CST to safely transport a patient to the Preoperative
Holding or OR.
1. To preserve the safety of the patient and CST, the following safety measures
should be implemented during the transport of the patient. The CST should
explain all actions to the conscious patient just prior to and while performing the
action, e.g., placing safety strap, elevating side rails and to keep fingers out of the
way, raising head of bed at patient’s request, going headfirst into an elevator.
A. The side rails of a stretcher must be elevated.
1) Prior to raising the side rails the CST must verbally
communicate to the patient to place his/her arms on their
abdomen, if possible, to prevent injury. The CST must
confirm the arms are out of the way.
2) If the patient is not able to move their arms, the CST should
raise each rail separately while gently moving the arm out
of harm’s way while raising the rail.
B. The stretcher safety strap must be applied. It should not be placed over
the abdomen to prevent interference with respirations. The CST should be
able to slide two fingers under the strap to confirm it is not too tight.
C. The CST should visually confirm IV lines, indwelling catheters,
monitoring system lines and drains, and any other lines are secure and
patent. The IV pole(s) should be positioned so the bag(s) is/are hanging to
the side and not above the patient’s head. The indwelling catheter urinary
bag or any other collecting bags must be positioned below the level of the
patient and not dragging on the floor.3
D. The CST should visually confirm the head, arms and legs are protected
and adequately padded, and verbally confirm with the patient that he/she is
as comfortable as possible.
1) While transporting the patient, the CST should verbally
remind the patient to keep his/her hands and arms inside the
safety rails to prevent injury.
2) The CST must always maintain the dignity of the patient by
keeping him/her covered with blankets and/or sheets.
E. The patient should be transported feet first; rapid movements, particularly
when going around a corner should be avoided.2
Rapid movements,
especially if the patient has received preoperative medications, can cause
the patient to become disoriented, dizzy, and nauseated, and induce
vomiting.7
F. The CST should be positioned at the patient’s head when pushing the
stretcher so he/she can look ahead to identify potential hazards. This also
allows immediate access to the patient’s airway in the case of respiratory
distress or vomiting.
If two CSTs are available for transporting the patient, the second
person should be positioned at the foot of the stretcher. It is the
responsibility of the CST at the head of the bed to communicate any
upcoming potential hazards to the CST at the foot of the stretcher.

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G. The CST must never use the stretcher or transportation device to force
open any doors.
H. When using an elevator, the elevator doors should be locked and the
patient is transported headfirst into the elevator when using a crib or
stretcher.2
If using a wheel chair, the CST should back into the elevator.
I. The patient should never be left unattended/abandoned during the
transportation process.
1) When transporting a patient, the CST has accepted the
patient assignment, thus establishing a CST-patient
relationship that is continued until the CST has handed-off
the care of the patient to another HCW.8
2) Abandonment of the patient increases the risk of patient
injury and inability to monitor the patient. Additionally,
remaining with the patient provides emotional comfort and
helps to lessen the patient’s level of anxiety.
J. During the transportation process, the CST must remain observant of the
patient for signs of physical or emotional distress.
Guideline III
It is the responsibility of the surgery team to safely transfer a patient from a
transportation device to the OR table.
1. To ensure the safety of the patient and surgery team, the following safety
measures should be applied during the transfer of the patient.
A. When using a stretcher, it should always be positioned by comparing the
patient’s body length to the OR table.
B. The wheels of the transportation device and OR table must be locked.
C. The team must confirm that IV lines, indwelling catheters, monitoring
system lines and drains are secure and not entangled to prevent dislodging.
The catheters, drains and lines must be moved and positioned prior to
moving the patient, e.g. IV bag and line transferred to the standing IV
pole.
D. The correct number of surgery personnel must be used to transfer the
patient from the stretcher to the OR table to safeguard the safety of the
patient and surgical team.
1) For conscious, mobile patients, a minimum of two surgery
personnel is necessary; non-mobile, conscious or
unconscious patient, a minimum of four surgery personnel
is necessary.
2) For the non-mobile patient, a patient transfer device should
be used.
E. The anesthesia provider is responsible for indicating when the patient can
move himself/herself over to the OR table, or for the non-mobile patient,
the anesthesia provider should verbally indicate to the surgery team when
the patient can be moved.2,7
The anesthesia provider must be responsible
for protecting the head, neck and airway of the patient during transfer.2,7

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F. The surgery team should use smooth, even movements when transferring
the non-mobile patient to avoid injury; the patient should not be dragged
onto the OR table from the transportation device. Dragging or bouncing
the patient can provoke decompensated perfusion and cause physical
injury to the patient.7
G. The patient should be centered on the OR table and the safety strap placed
across the thighs approximately two inches above the knee joints. Two
fingers should be able to be placed under the safety strap to ensure it is not
too tight.
H. The surgery team must confirm bony areas of the patient’s body are well-
padded and not resting on any metal portion of the OR table.
2. The following patient care concepts should be fulfilled during the transfer of the
patient.
A. The dignity of the patient should be maintained throughout the transfer
process by keeping him/her covered. The unconscious or heavily sedated
patient relies upon the ethics and integrity of the surgical team.
B. A surgical team member should explain all actions to the conscious patient
as to what is occurring in preparation for the transfer and during the
transfer.
C. A surgical team member should instruct the patient not to move until
given the command to do so by the anesthesia provider.
Guideline IV
The HDO should have a coordinated patient transport system (CPTS) in place for
transferring and transporting critically ill patients from the CCU (CICU), ICU, and
NICU to the surgery department.9
1. Critically ill patients are at an increased risk for morbidity and mortality during
intrahospital transfer.10-17
Risks can be minimized and outcomes improved with
careful planning through the cooperation of an interdisciplinary team, and
selection and use of equipment needed to provide uninterrupted care of the patient
during the transportation process.10,18
During transfer, the patient should be
receiving the equivalent level of monitoring and support that was provided in the
ICU.
A. The data from a study conducted from 2006-2010 involving 1,557 patient
transfers of ICU patients to surgery implementing a CPTS found that there
was a fourfold improvement in on-time OR starts while also significantly
reducing the idle OR time.9
The results confirm that a CPTS can
considerably improve OR efficiency while ensuring quality, safe care of
the patient.
B. The HDO should conduct a comprehensive analysis of the following
elements to develop a written standardized CPTS for the intrahospital
transfer of patients.
1) A multidisciplinary team that includes surgeons, CSTs,
RNs, respiratory therapists, and HDO administration should
be formed to plan and coordinate the assessment process.

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2) The team should complete an assessment of the patient
demographics, transfer volume, transfer patterns,
communication processes, and available equipment and
personnel.18
3) Using the gathered information, the team should develop a
written standardized CPTS that is then implemented.
4) The team should evaluate and revise the transfer plan on a
periodic basis using a quality improvement process.18
C. The CPTS should address four components: pretransport coordination and
communication; accompanying personnel; accompanying equipment;
monitoring during transport.18
1) Continuity of patient care is achieved when the transferring
team and receiving team follow the standardized
pretransport steps of communication each time patient care
responsibility is transferred. Before transport the receiving
team should communicate to the transferring team they are
ready to receive the patient for surgery. Other members of
the transfer team, including the surgeon, are informed of
the timing of the transport and the required equipment.18
It
should be documented in the patient’s medical record the
indications for transport, time of transport, and patient’s
status.18
2) It is recommended that a minimum of two people, not
including the person pushing the transportation device that
could be a CST, accompany the transport of the critically ill
patient.18
It is strongly recommended a physician or the
surgeon accompany the patient along with a respiratory
therapist. For unstable critically ill patients, additional
support personnel may be needed such as a RN. The CST
can also serve as a support person in providing patient care
under the direction and supervision of the physician on the
transferring or receiving team.
3) It must be confirmed prior to transfer that all battery-
operated equipment is fully charged. The mandatory
equipment to accompany every critically ill patient
includes: blood pressure monitor; pulse oximeter; cardiac
monitor; cardiac defibrillator; and airway management
supplies including an oxygen source that has a 30-minute
reserve.16,18
Basic resuscitation drugs should accompany
the patient including epinephrine and other antiarrhythmic
agents in the event of sudden cardiac arrest or arrhythmia.18
The same equipment and drugs should accompany the
transfer of a pediatric patient making the adjustments for
size of patient.17
Bag-valve ventilation (Ambu bag) is most
commonly used during intrahospital transfers; however, the

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use of portable mechanical ventilators has gained
support.14,18
If a mechanical ventilator is used, the transfer
team including the CST should confirm that the alarms are
working to indicate disconnection and increased airway
pressures in the patient.14,18
The transfer team should make
sure a fully-charged backup battery power supply is
transferred with the patient who is on a mechanical
ventilator.
4) Minimally, during transfer, monitoring of the patient
should include continuous electrocardiography, pulse
oximetry, blood pressure, pulse and respiratory rates.15,18
(Warren)
5) The surgery department (receiving area) should have
equivalent equipment including mechanical ventilator, that
is used to provide the same level of patient monitoring and
support provided in the ICU.
Guideline V
The surgery department should review the policies and procedures (P&P) regarding
transferring and transporting surgical patients on an annual basis.
1. The surgery department should include members of the surgical team and
administration when reviewing the P&Ps, including CSTs, surgeons, RNs, risk
management, and infection control officer.
A. The surgery department should document when the P&Ps were reviewed,
revision completed (if necessary), and who participated in the review
process.
2. CSTs should be familiar with the P&Ps for transferring and transporting surgical
patients. The orientation of new employees should include reviewing the P&Ps.
Guideline VI
CSTs should complete continuing education to remain current in their knowledge of
transferring and transporting the surgical patient.19
1. The continuing education should be based upon the concepts of adult learning,
referred to as andragogy. Adults learn best when the information is relevant to
their work experience; the information is practical, rather than academic; and the
learner is actively involved in the learning process.20
2. It is recommended surgery departments use various methods of instruction to
facilitate the learning process of CSTs.
A. If the education is primarily lecture, methods to engage learners include
presentation of case studies for discussion, and audience discussion
providing suggestions for reinforcing transferring and transporting
surgical patients.
B. Other proven educational methods include interactive training videos, and
computerized training modules and teleconferences.
C. The continuing education should be delivered over short periods of time
such as in modules, and not in a one-time lengthy educational session.

9. 9
3. Continuing education programs should be periodically evaluated for effectiveness
including receiving feedback from surgery department personnel.
4. The surgery department should maintain education records for a minimum of
three years that include dates of education; names and job titles of employees that
completed the continuing education; synopsis of each continuing education
session provided; names, credentials, and experience of instructors.
Competency Statements
Competency Statements Measurable Criteria
1. CSTs have the knowledge and skills for
operating various patient transportation
devices in a safe manner to prevent injury
to the patient and HCP.
2. CSTs have the knowledge and skills to
perform the patient care concepts as
related to transporting the surgical patient.
3. CSTs have the knowledge and skills to
work with the surgical team when
transferring the patient from the
transportation device to the OR table.
1. Educational standards as established
by the Core Curriculum for Surgical
Technology.21
2. The didactic subjects of transporting
the surgical patient as well as transferring
from bed to transportation device to OR
table and patient care concepts is included
in a CAAHEP accredited surgical
technology program.
3. Students demonstrate knowledge of
transporting the surgical patient as well as
transferring from bed to transportation
device to OR table and patient care
concepts in the lab/mock OR and during
clinical rotation.
4. As practitioner’s, CSTs perform
transportation of the surgical patient as
well as transferring from bed to
transportation device to OR table and
patient care concepts while applying
patient safety concepts.
5. CSTs complete continuing education
to remain current in their knowledge of
safe transfer and transportation of the
surgical patient, including following the
policies and procedures of the HDO.19
CST® is a registered trademark of the National Board of Surgical Technology and Surgical Assisting
(NBSTSA).

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Glossary
Coordinated patient transport system (CPTS): Standardized plan for transferring and
transporting critically ill patients from the CCU, ICU or NICU to the surgery department
to ensure the same level of monitoring and patient support is provided during transport.
Intrahospital transfer: The transfer of a patient from one department/unit or ward to
another department/unit of the HDO for short-term treatment or testing, e.g., radiology or
surgery department.
Patient monitoring: Equipment used to monitor the physiological processes of the patient
including electrocardiography, pulse oximetry, blood pressure, pulse and respiratory
rates.
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