6.6 Transfer Critically Ill Flashcards
You are asked to transfer a 43-year-old male patient from an intensive care
unit to a specialised neurointensive care unit in a hospital 1 hour away by
ambulance.
a) What are the technical risks with regards to the transfer of
patients from critical care units?
● Need a high level of care.
● Appropriately stabilised and resuscitated before transfer.
● Requires physical movement.
● Restricts positioning, monitoring, intervention and examination.
● Ventilation, BP maintenance and heart rhythm maintenance could be problematic.
● Unreliable power for equipment for monitoring, infusion pumps and ventilation.
● Unreliable oxygen supply.
● Venous access problems during transfer and mobilisation.
● Problems with transfer equipment.
b) What are the non-technical risks that are to be noted during
the transfer of critical care patients?
● Non-availability of adequate staff for the
transfer compared with intensive care units.
● Work in isolation during transfer.
● Teams might be unfamiliar with each other and the patient.
● Issues with communication and liaison
with different critical care units.
c) Describe the organisational risks in the transfer of critically ill
patients.
● Need to be aware of guidelines from the Association of Anaesthetists of Great Britain & Ireland (AAGBI), Royal College of Anaesthetists (RCoA) and Intensive Care Society (ICS).
● The hospital should have a designated consultant for transfers and audit/training.
● Standardisation of protocols, equipment and documentation.
● More burden on the preparing staff and the remaining staff.
● Must not jeopardise the remaining patients.
● Accompanying staff to be safely returned to base after transfer.
● A dedicated transfer service is ideal
d) What guidelines are you aware of regarding the transfer of
critically ill patients?
● AAGBI guidelines 2009, 2006.
● ICS guidelines, 2011.
● NICE guidelines NG94, July 2017.
● Scottish Intercollegiate Guidelines Network,
SIGN 139, May 2014.
e) What would you consider in the process of transfer?
● Who? —
the decision to transfer should
be agreed with senior responsible consultants and team.
● With whom? —
trained personnel, teamwork.
● When? —
well prepared transfer,
striking a balance between speed and safety.
● How? —
appropriate and careful preparation,
guidelines to be followed and a
pre-departure checklist to be used.
● With what? —
drugs, equipment, mode of transport
f) Describe the essentialities in an ABCDE approach with regard to the transfer of a sick patient.
● A —
secure tracheal tubes, check and record before the transfer.
● B —
adequate ventilation, saturation probes, etCO2 monitoring,
release pneumothorax, calculate oxygen needs, bag valve masks in need.
● C —
appropriate resuscitation, two IV access sites secured well,
arterial and other lines secured, vasopressors calculated, specialist equipment if needed.
● D —
sedation/analgesia/paralysis,
pumps for infusions,
seizures to be well controlled.
● E —
immobilisation of trauma patients as appropriate,
all drains and tubes fixed securely,
avoid hypothermia and monitor.
● Packaging —
take care to avoid heat loss and injury,
and avoid pressure areas.
● Documentation —
every 5 minutes for vital signs,
standardised across networks,
duplicates for audit and incident reporting.
g) List the communication processes that are essential in the
transfer of sick patients.
● Firstly, referring and receiving senior consultants should discuss the transfer.
● The referring unit should document a care summary and handover letter.
● The transfer team should receive a handover in detail.
● The transfer team should hand over the patient clearly to medical and nursing staff, with details of any change during the transfer.
