Inter-hospital Transfer of the Critically Ill

Introduction: Ten thousand inter-hospital transfers of critically ill adults take place annually in the UK. Studies highlight deficiencies in experience and training of staff, equipment, stabilisation before departure, and logistical difficulties. This article is a quality improvement review of an advanced critical care practitioner (ACCP)-led inter-hospital transfer service. Methods: The tool Standards for Quality Improvement Reporting Excellence was used as the format for the review, combined with clinical audit of advanced critical care practitioner-led transfers over a period of more than 3 years. Results: The transfer service has operated for 8 years; ACCPs conducted 934 critical care transfers of mechanically ventilated patients, including 286 inter-hospital transfers, between January 2017 and September 2020. The acuity of transfer patients was high, 82.2% required support of more than one organ, 49% required more than 50% oxygen. Uneventful transfer occurred in 81.4% of cases; the most common patient-related complication being hypotension, logistical issues were responsible for half of the complications. Conclusion: This quality improvement project provides an example of safe and effective advanced practice in an area that is traditionally a medically led domain. ACCPs can provide an alternative process of care for critically ill adults who require external transfer, and a benchmark for audit and quality improvement.

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The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds - a single-centre retrospective analysis

Journal of Intensive Care ◽

10.1186/s40560-020-00501-z ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Jonatan Oras ◽

Marko Strube ◽

Christian Rylander

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Primary Analysis ◽

Saps 3 ◽

Propensity Score Model ◽

Risk Of Death ◽

Tertiary Centre ◽

Hospital Transfer ◽

Secondary Analyses

Abstract Background Patients in the intensive care unit (ICU) are increasingly being transferred between ICUs due to a shortage of ICU beds, although this practice is potentially harmful. However, in tertiary units, the transfer of patients who are not in need of highly specialized care is often necessary. The aim of this study was to assess the association between a 90-day mortality and inter-hospital transfer due to a shortage of ICU beds in a tertiary centre. Methods Data were retrieved from the local ICU database from December 2011 to September 2019. The primary analysis was a risk-adjusted logistic regression model. Secondary analyses comprised case/control (transfer/non-transfer) matching. Results A total of 573 patients were transferred due to a shortage of ICU beds, and 8106 patients were not transferred. Crude 90-day mortality was higher in patients transferred due to a shortage of beds (189 patients (33%) vs 2188 patients (27%), p = 0.002). In the primary, risk-adjusted analysis, the risk of death at 90 days was similar between the groups (odds ratio 0.923, 95% confidence interval 0.75–1.14, p = 0.461). In the secondary analyses, a 90-day mortality was similar in transferred and non-transferred patients matched according to SAPS 3-score, age, days in the ICU and ICU diagnosis (p = 0.407); SOFA score on the day of discharge, ICU diagnosis and age (p = 0.634); or in a propensity score model (p = 0.229). Conclusion Mortality at 90 days in critically ill patients treated in a tertiary centre was not affected by transfer to another intensive care units due to a shortage of beds. We found this conclusion to be valid under the assumption that patients are carefully selected and that the transports are safely performed.

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Transport of the critically ill patient

10.1093/med/9780199642045.003.0090 ◽

2017 ◽

Author(s):

Laura Flutter ◽

Christoph Melzer-Gartzke ◽

Claudia Spies ◽

Julian Bion

Keyword(s):

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Best Practice ◽

Ad Hoc ◽

Critically Ill Patient ◽

National Guidelines ◽

Specialist Services ◽

Hospital Transfer ◽

Safe Transport

The safe transport of critically ill patients is recognized internationally as a key competency for clinicians working in anaesthesia, critical care, and emergency medicine. This includes inter- and intra-hospital, land, and air transport. The centralization of specialist services and growing demand for critical care beds have increased pressure on hospitals to provide transfer support for critically ill patients. A variety of systems have emerged to facilitate the increasing need for both inter- and intra-hospital transfer of patients, ranging from a national coordinated retrieval service to the ad hoc utilization of on-call teams. The potential for complications during all types of transfer has been well documented. In order to improve safety, a number of national guidelines and courses have been developed to provide a standardized approach to transfer medicine. This chapter reviews the current literature on the subject and provides a summary of best practice for the transfer of the critically ill patient.

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Inter Hospital Transfer of Critically Ill Neonates-Challenges Faced

Journal of Pediatrics & Neonatal Care ◽

10.15406/jpnc.2017.06.00235 ◽

2017 ◽

Vol 6 (2) ◽

Cited By ~ 1

Author(s):

Pradyumna Pan

Keyword(s):

Critically Ill ◽

Hospital Transfer ◽

Critically Ill Neonates

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In-hospital transfer of the critically ill

10.1093/med/9780199600830.003.0004 ◽

2016 ◽

Author(s):

Lorna Eyre ◽

Simon Whiteley

Keyword(s):

Adverse Events ◽

Critically Ill ◽

Vascular Access ◽

Critically Ill Patients ◽

Morbidity And Mortality ◽

Critically Ill Patient ◽

Vascular Access Devices ◽

Endotracheal Tubes ◽

High Incidence ◽

Hospital Transfer

While focus has traditionally been on the planning, logistics, and outcome of inter-hospital transfers of the critically-ill patient, attention is turning to in-hospital transfers. Numerically, more in-hospital transfers occur and there is growing evidence that these are associated with a high incidence of adverse events, and increased morbidity and mortality. Appropriate planning, communication, and preparation are essential. Patients should be resuscitated and stabilized (optimized) prior to transfer, to prevent deterioration or instability during transfer. Endotracheal tubes and vascular access devices should be secure. The minimum recommended standards of monitoring should be applied. All drugs and equipment likely to be required during the transfer should be checked and available. Critically-ill patients should be accompanied by personnel with the appropriate knowledge skills and experience to carry out the transfer safely and to deal with any complications or incidents that arise.

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