Critical care in the emergency department: patient transfer

Resource implications of Inter-facility Transport between Emergency Departments in Hong Kong

“…The course is a 2 day intensive training course, which includes quick assessment of the patient before transport, airway management, ECG, pharmacology, intravenous therapy, ambulance safety, management of en route deterioration and practical sessions with hands-on experience in the ambulance. Transport personnel should be experienced and competent in transport medicine, trained in airway management, Advanced Cardiac Life Support (ACLS) and experienced in critical care 11. In AHNH ED, all staffs are ACLS providers, whereas 95% of staffs are Advanced Trauma Life Support /Trauma Nursing Core Course providers and 96% of staff have a certificate in airway management.…”

Scant justification for interhospital transfers: a cause of reduced efficiency in the emergency department

“…Therefore, the doctor must take into account both the risks and the benefits of a transfer, which should be prepared according to well-defined criteria:4 17 – 19 (1) information to be given to the patient and his or her relatives; (2) communication between the transferring and the receiving doctors; (3) stabilisation of the patient’s condition; (4) transport safety; (5) reception by ambulance crew; (6) identification of transfer-admitting personnel and assurance of bed availability in the specialist unit.…”

“…Lack of health operator training in the process of decision-making and organisation of transfers has been considered by the literature to be one of the causes of unjustified transfers 4 11 16 20 21. Statistical analysis of our data was aimed at identifying factors leading to unjustified transfers: a few factors concerning the patient have turned out to be statistically significant.…”

“…Burt et al 3 further described the extent of this phenomenon, suggesting the lack of beds, the high number of admissions to ED (14% by ambulance) and the complexity of cases as the reasons behind the transfers. In 2007, Dunn et al 4 published a comprehensive review of interhospital transfers of critical patients in the UK, highlighting all the difficulties concerning the different phases of transfer organisation.…”

Risk management during inter-hospital transfer of critically ill patients: making the journey safe

“…Morbidity and mortality associated with a transfer may be reduced by focusing on pretransfer stabilisation,5 the anticipation and management of hazards6 and selection of the correct personnel, equipment and communication tools required 7…”