Ten thousand inter-hospital transfers of critically ill adults take place annually in the UK. Studies highlight deficiencies in the experience and training of staff, equipment, stabilisation before departure, and logistical difficulties. This article here was written as a quality improvement review of an advanced critical care practitioner (ACCP)-led inter-hospital transfer service.
Between January 2017 and September 2020, advanced critical care practitioners conducted 934 transfers of mechanically ventilated patients without direct doctor supervision. A total of 286 of these were inter-hospital transfers. In the majority of inter-hospital transfers, the lack of critical care beds in the original hospital (52.8%, 151) was the indication. The second most frequent indication for transfer was the need for specialist care in a tertiary centre, largely for neurosurgical intervention (29%, 83).
The acuity of transfer patients was high, 82.2% required the 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, and logistical issues were responsible for half of the complications.
When conducting such inter-transfers, various equipment may be required to stabilise critically ill patients despite the fact that space inside vehicles is generally limited. On top of usual respiratory support equipment, treatment of hypotension, for instance, may include the use of intravenous fluids, vasopressors, etc. Equipping transport vehicles with compact medical devices as well as reducing unnecessary set-up procedures can potentially improve the quality of inter-hospital transfer service.
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