Anesthesiologists must be constantly vigilant to prevent injuries to patients during the perioperative period. One often under-recognized hazard is the bed-to-bed transfer at the start and end of nearly every surgical procedure. This process can create risk, particularly for those patients who are unable to assist with the transfer. The risk for patient harm from this seemingly simple procedure is frequently overlooked, since it is a daily occurrence in the OR.
One example of a catastrophic event would be if a patient were to fall from the bed or stretcher during transfer, leading to injury, medical liability, and negative publicity. Another possible mechanism of injury is the accidental dislodgement of tubes, lines, or drains. Although unplanned removal of tubes and catheters can be very prevalent in the hospital setting, the occurrence is thought to be uncommon in the OR, and very little is written about it in the published literature...