Interhospital transfer of the Critically Ill Royal College of Anaesthetists 4th November 2006

1
Interhospital transfer 2009
2
Interhospital transfer
Working Party members
Dr D Goldhill Chairman Dr L Gemmell Dr D
Lutman Dr S McDevitt Dr M Parris Dr C
Waldmann Dr C Dodds
3
Reasons for transfer clinical neuro / burns /
spinal injury / dialysis / cardiothoracic / AAA
/ MaxFax / angio non-clinical bed
pressures repatriation
4
Pressures relative lack of critical care capacity
Edbrooke D, Hibbert C, Corcoran M. Review for the
NHS executive of adult critical care services,
May 2000
5
Pressures specialisation and centralisation
training to address the situation where a very
sick child turns up at the wrong place concern
about hospitals with no on-site inpatient
paediatric facilities providing unrestricted
access via the AE under exceptional
circumstances a child may have to be managed in
an adult ICU
6
Pressures specialisation and centralisation
ST-elevated myocardial infarction acute PCI
requires 32 centres for England Widimsky P et
al. Eur Heart J. 2007 Mar28(6)679-84.
Consultant-led maternity services for hospitals
serving 250,000 populations and
2,500 deliveries/year Neurosurgery mortality for
severe head injury 26 higher in
non-neurosurgical centres
Kings fund briefing, November 2007
7
Interhospital transfers
25 for non-clinical reasons many carried out by
inexperienced trainees 90 anaesthetists prolonged
time (median 3 hours) before transfer many
outside of normal working hours 15 critical
incident rate
Jameson PPM et al Anaesthesia 200055489-90 Mack
enzie PA et al BMJ 19973141455-6 Gray A et al
EMJ 200320242-6 Spencer C et al Anaesthesia
2004591248-9
8
Neuro Critical Care Brain injury
High quality transfer improves outcome Resuscitati
on and stabilisation before transfer GCS lt8
should be intubated and ventilated Accompanied by
doctor with appropriate training and experience
Aim for a maximum of 4 hours from injury to
surgery Avoid secondary brain injury MAP gt80
mmHg PaO2 gt13 kPa PaCO2 4.5 to 5.0 kPa
9
Neuro Critical Care Brain injury
fundamental requirement is that every doctor,
nurse and paramedic likely to be involved in the
transfer of seriously ill brain injured patients
has had formal training...
10
Equipment standard ambulance trolleys are
generally unsuitable mount at or below
patient gravity feed drips unreliable Accompanying
Personnel appropriate training competent
in. suitably experienced nurse
11
Transport courses
12
Educational Resources
13
RCoA Audits on Transfer
14
INTERHOSPITAL TRANSFER 2008
Recommendations

• Transfer can be safely accomplished
• 2. Non-clinical transfers should only take place
  in exceptional circumstances
• The decision must involve a senior and
  experienced clinician
• 4. Hospitals should form transfer networks
• Networks should take responsibility for
  arrangements
• Protocols, documentation and equipment should be
  standardised
• 7. All personnel should have the appropriate
  competencies, qualifications and experience.

15
INTERHOSPITAL TRANSFER 2008
Recommendations
8. A professional, dedicated transfer service is
the preferred method for suitable patients. 9.
Hospitals must ensure suitable transfer
equipment is provided 10. Hospitals must have
robust arrangements to ensure that sending
personnel on a transfer does not jeopardise other
work 11. Hospitals must ensure that employees
have adequate insurance cover 12. Arrangements
must be made to return personnel and equipment
safely and promptly to base 13. Details must be
recorded and subject to regular audit and review