Transferring Critically Ill Patients


FIGURE 11.1 Example of an intrahospital transport checklist developed by Brunsveld-Reinders et al. (From Brunsveld-Reinders AH, Arbous MS, Kuiper SG, de Jonge E. A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. Crit Care. 2015;19:214.)




For quality purposes, the transfer organization should keep record of all transfers.


Conclusion

Transporting critically ill patients is crucial to the public health system and will continue to be of vital importance in the future. Although every transport is a potential risk for our patient, it can be performed safely when circumstances are optimized. Transport teams with both experience in treating critically ill patients as well as insight into risks related to the actual transfer can provide such a safe transfer; this is as true with inter- as with intrahospital transports/transfers.


Key Points




  • Interhospital transfer of critically ill patients should be carried out by specialized retrieval teams.
  • All involved in transport should receive transfer training.
  • Transfer training should focus on preparation, teamwork, equipment, mobility, and safety.
  • Equipment used should meet both ICU and transfer standards.

ACKNOWLEDGMENT


The authors thank the previous edition’s authors for their contributions.


References



  1. Mackenzie PA, Smith EA, Wallace PGM. Transfer of adults between intensive care units in the United Kingdom: postal survey. BMJ. 1997;314:1455–1455.
  2. Iwashyna TJ, Christie JD, Kahn JM, Asch DA. Uncharted paths: hospital networks in critical care. Chest. 2009;135:827–833.
  3. Iwashyna TJ, Christie JD, Moody J, et al. The structure of critical care transfer networks. Med Care. 2009;47:787–793.
  4. Kahn JM, Linde-Zwirble WT, Wunsch H, et al. Potential value of regionalized intensive care for mechanically ventilated medical patients. Am J Respir Crit Care Med. 2008;177:285–291.
  5. Gentleman D, Jennett B. Audit of transfer of unconscious head-injured patients to a neurosurgical unit. Lancet. 1990;335:330–334.
  6. Philpot C, Day S, Marcdante K, Gorelick M. Pediatric interhospital transport: diagnostic discordance and hospital mortality. Pediatr Crit Care Med. 2008;9:15–19.
  7. Barry PW, Ralston C. Adverse events occurring during interhospital transfer of the critically ill. Arch Dis Child. 1994;71:8–11.
  8. Gillman L, Leslie G, Williams T, et al. Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit. Emerg Med J. 2006;23:858–861.
  9. Wallen E, Venkataraman ST, Grosso MJ, et al. Intrahospital transport of critically ill pediatric patients. Crit Care Med. 1995;23:1588–1595.
  10. Rohan D, Dwyer R, Costello J, Phelan D. Audit of mobile intensive care ambulance service. Ir Med J. 2006;99:76–78.
  11. Ligtenberg JJM, Arnold LG, Stienstra Y, et al. Quality of interhospital transport of critically ill patients: a prospective audit. Crit Care. 2005; 9:R446–R451.
  12. Wiegersma JS, Droogh JM, Zijlstra JG, et al. Quality of interhospital transport of the critically ill: impact of a mobile intensive care unit with a specialized retrieval team. Crit Care. 2011;15:1122–1125.
  13. Droogh JM, Smit M, Hut J, de Vos R, et al. Inter-hospital transport of critically ill patients; expect surprises. Crit Care. 2012;16:R26.
  14. Hatherill M, Waggie Z, Reynolds L, Argent A. Transport of critically ill children in a resource-limited setting. Intensive Care Med. 2003;29:1547–1554.
  15. Beckmann U, Gillies DM, Berenholtz SM, et al. Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med. 2004;30:1579–1585.
  16. Flabouris A, Runciman WB, Levings B. Incidents during out-of-hospital patient transportation. Anaesth Intensive Care. 2006;34:228–236.
  17. Papson JPN, Russell KL, Taylor DM. Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med. 2007;14:574–577.
  18. Henning R, McNamara V. Difficulties encountered in transport of the critically ill child. Pediatr Emerg Care. 2012;7:133–137.
  19. Vos GD, Nissen AC, Nieman F, et al. Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team. Intensive Care Med. 2004;30:302–308.
  20. Edge WE, Kanter RK, Weigle CG, Walsh RF. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med. 1994; 22:1186–1191.
  21. Macnab AJ. Optimal escort for interhospital transport of pediatric emergencies. J Trauma: Injury, Infection, and Critical Care. 1991;31:205–209.
  22. Bellingan G, Olivier T, Batson S, Webb A. Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients. Intensive Care Med. 2000;26:740–744.
  23. Ramnarayan P, Thiru K, Parslow RC, et al. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet. 2010;376:698–704.
  24. Droogh JM, Smit M, Absalom AR, et al. Transferring the critically ill patient: are we there yet? Crit Care. 2015;19:749.
  25. Britto J, Nadel S, Maconochie I, Levin M, Habibi P. Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team. BMJ. 1995;311:836–839.
  26. Wedel SK, Orr RA, Frakes MA, Conn AKT. Improving the incomplete infrastructure for interhospital patient transfer. Crit Care Med. 2013; 41:e21–e22.
  27. Iwashyna TJ. The incomplete infrastructure for interhospital patient transfer. Crit Care Med. 2012;40:2470–2478.
  28. Vos GD, Nieman FHM, Meurs AMB, et al. Problems in interhospital pediatric intensive care transport in the Netherlands: results from a survey of general pediatricians. Intensive Care Med. 2003;29:1555–1559.
  29. Droogh JM, Kruger HL, Ligtenberg JJM, Zijlstra JG. Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU. Jt Comm J Qual Patient Safe. 2012;38:554–559.
  30. Wallace PG, Ridley SA. ABC of intensive care. Transport of critically ill patients. BMJ. 1999;319:368–371.
  31. Bion JF, Manji M. Transporting critically ill patients. Intensive Care Med. 1995;21:781–783.
  32. Spencer C, Watkinson P, McCluskey A. Training and assessment of competency of trainees in the transfer of critically ill patients. Anaesthesia. 2004; 59:1248–1249.
  33. Cosgrove JF, Kilner AJ, Batchelor AM, et al. Training and assessment of competency in the transfer of critically ill patients. Anaesthesia. 2005; 60:413–414.
  34. Bérubé M, Bernard F, Marion H, et al. Impact of a preventive programme on the occurrence of incidents during the transport of critically ill patients. Intensive Crit Care Nurs. 2013;29:9–19.
  35. Esmail R, Banack D, Cummings C, et al; Patient Safety and Adverse Events Team: Is your patient ready for transport? Developing an ICU patient transport decision scorecard. Healthc Q. 2006;9(Spec No.):80–86.
  36. Jarden RJ, Quirke S. Improving safety and documentation in intrahospital transport: development of an intrahospital transport tool for critically ill patients. Intensive & Crit Care Nurs. 2010;26:101–107.
  37. Brunsveld-Reinders AH, Arbous MS, Kuiper SG, de Jonge E. A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients. Crit Care. 2015;19:214.
  38. Pearl RG, Mihm FG, Rosenthal MH. Care of the adult patient during transport. Int Anesthesiol Clin. 1987;25:43–75.
  39. Warren J, Fromm RE, Orr RA, et al; American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32:256–262.
  40. Guidelines Committee of the American College of Critical Care Medicine; Society of Critical Care Medicine and American Association of Critical-Care Nurses Transfer Guidelines Task Force. Guidelines for the transfer of critically ill patients. Crit Care Med. 1993;6:931–937.
  41. Vos GD, Buurman WA, van Waardenburg DA, et al. Interhospital paediatric intensive care transport: a novel transport unit based on a standard ambulance trolley. Eur J Emerg Med. 2003;10:195–199.
  42. Borst GM, Davies SW, Waibel BH, et al. When birds can’t fly. J Trauma Acute Care Surg. 2014;77:331–337.

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Feb 26, 2020 | Posted by in CRITICAL CARE | Comments Off on Transferring Critically Ill Patients

Full access? Get Clinical Tree

Get Clinical Tree app for offline access