Preparing The Critically Ill Adult Patient for Transfer

Abstract

Background

The reorganisation of hospital services in Ireland, the development of hospital groups, centralisation of specialties and reconfiguring of smaller hospitals necessitates inter hospital transfer of patients requiring specialist care to an appropriate hospital that meets their clinical needs. In Ireland, in excess of 1000 adult critical care inter hospital transfers occur per annum(1). The ‘hub-and-spoke’ model is aligned with the hospital group structure and connectivity between hospitals is provided through agreed transport and retrieval services. These transfers are generally undertaken by local teams (usually an anaesthetic NCHD and a nurse) using an emergency ambulance and crew. Multidisciplinary team training is provided, by Critical Care Retrieval Services, using local resources in a framework enhancing safety and preparedness.

Aims

A critical care transfer checklist with a systematic approach provides a framework to address the elements of critical care, transport physiology changes and reduce potential adverse events when transferring critically ill patients (2). The use of transport specific adjuncts and packaging the patient systematically not only addresses transport issues e.g. temperature, but also facilitates emergency interventions en route.

Conclusion

Patient safety is a fundamental principle in healthcare and is the responsibility of healthcare practitioners to apply quality improvement methods to effect process and system improvements. The use of a systematic approach to patient management when transporting critically ill patients establishes a higher level of performance reduces cognitive dissonance and provides a framework for clinical teams and reduces the potential for human error (3).