Satisfaction of patients’ next of kin in a ‘Hub & Spoke’ ICU network

Abstract

SummaryThis study aimed to gauge the opinions of patients' next of kin regarding transfer of patients from the specialist ‘Hub’ intensive care unit, to ‘Spoke’ intensive care units near home. We included 213 consecutive patients with severe trauma or severe acute neurological conditions admitted to the Hub intensive care unit over a 21‐month period, who were repatriated to Spoke intensive care units for ongoing intensive care. One year after admission to the Hub intensive care unit, two thirds of patients' next of kin said they would have preferred patients to have been treated only in the Hub intensive care unit, and not repatriated. They perceived Hub intensive care unit care to be important, and would have preferred that their relatives be hospitalised there until intensive treatment was completed. The next of kin's preference was associated with severe acute neurological conditions (p ≤ 0.0001). Although centralised Hub & Spoke intensive care unit networks are appropriate to ensure specialised care, repatriation to local hospitals may not be appropriate for patients with severe neurological conditions.

Regionalisation of critical care: can we sustain an intensive care unit in every hospital?

“…In a study of patients' family attitudes in one such setting, published in this issue of Anaesthesia, Chieregato and colleagues describe an attitude survey of the next of kin of 213 consecutive patients admitted to a networked neurosurgical 'hub' ICU in Italy [4]. The service covers approximately one million inhabitants, receiving referrals from six 'spoke' hospitals, and transfers patients back to their originating ICU once specialist treatment is complete.…”

How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study

“…The system embraces the concept of back transferring patients from the hub to the spoke, once they have been stabilised and specialist problems have been solved. 12 The intensive care unit (ICU) network is further supported by a network of rehabilitation units. 13…”

Emergently planned exclusive hub-and-spoke system in the epicenter of the first wave of COVID-19 pandemic in Italy: the experience of the largest COVID-19-free ICU hub for time-dependent diseases

“…Admission to COVID-19-free ICU was allowed only after ruling out SARS-CoV-2 through a negative nasopharyngeal swab (patients were held in a dedicated room for six hours while awaiting the results). Family visiting and interview policies were unchanged in the COVID-19-free ICU, with the policy to restrict the visit to only one relative per patient per time 12 . Of note, given the unprecedent situation, no proxy was systematically collected by the regional health system to test the efficiency of the emergently planned hub-and-spoke system.…”