Issues with patient transfer
Patient transfers occur for various reasons:
- Clinical need i.e. they need to go to a specialist centre for further management.
- Repatriation of previously transferred patients.
- Lack of critical care beds.
The Intensive Care Society (ICS) has attempted to estimate the number of critical care patient transfers per year in the UK and arrived at a conservative figure of 4,500. This figure is extrapolated from the ICNARC data which is not complete, so they acknowledge that there may be more transfers than that number. There is also, possibly, a higher number of level 2 patients compared to level 3.
From personal experience, I would rather transfer the level 3 patient as I feel that they are more ‘managed’ prior to transfer and one has more control over potential problems. If you like, they have less far to fall!
In an ICS survey;
- less than 30% of hospitals had a dedicated transfer trolley.
- 61% of transfers happened between 5pm – 9am.
- 58% of patients were escorted by SHOs.
- Critical incidents occurred in 20% of transfers.
Critically ill patients are at increased risk of morbidity and mortality during patient transfers. The patient, in the back of the ambulance, is in a noisy difficult, moving and potentially more dangerous environment than if they were in an intensive care unit. These transfers often take place at short notice and will frequently occur from the emergency medicine department which may not always be best prepared to make the process a smooth one, according to the ICS:
“Looking specifically at the organization of transfers from EDs, there are also widespread deficiencies in equipment provision, patient monitoring facilities, staff training and transfer documentation. Only 44% of EDs were aware that they belong to a critical care network, whilst only 57% had transfer guidelines available in the department.”
Monitoring needs to continue during transfer, as does possible drug infusion and the staff accompanying the patient need to be trained to make this possible. The AAGBI states in its recommendations:
“All doctors and other personnel undertaking transfers should have the appropriate competencies, qualifications and experience. It is highly desirable that this should include attendance at a suitable transfer course.”
The ICS endorses this view also:
“All staff potentially involved in the transport of critically ill patients should receive appropriate training in transfer medicine, and have the opportunity to gain experience in a supernumerary capacity”
There are now many courses available for this type of training some of which I provide links to below: