Transfer of the critically ill adult patient

Macartney, Ian; Nightingale, Peter

doi:10.1093/bjacepd/1.1.12

Cited by 8 publications

(10 citation statements)

References 4 publications

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“…These issues have been highlighted by both training courses 10 and previous publications. 17 18 Critical care transfers (unpublished data, Alasdair Gray) originating from the ED account for 25%-30% of all transfers and emergency medicine specialists are closely involved in liaison with and organisation of ambulance services. Emergency medicine should, therefore, be central to any organisational developments in transportation of the critically ill and injured.…”

Section: Discussionmentioning

confidence: 99%

Descriptive epidemiology of adult critical care transfers from the emergency department

Gray

Gill²,

Airey³

et al. 2003

Emergency Medicine Journal

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Aims: To describe the nature, frequency, and characteristics of adult critical care transfers originating from the emergency department (ED). Methods: A one year prospective regional descriptive study using multiple data sources of all critically ill adults transferred from an ED or a minor injuries unit (MIU) within the former Yorkshire Regional Health Authority Area or into a regional critical care facility if originating from an ED or MIU elsewhere. Results: 29 EDs transferred 349 adults into the regional critical care facilities. The median number of transfers per department within the region was 18 (range 1 to 42). Seventeen were transferred from outside the region. A total of 263 (75%) patients were transferred for specialist care and 76 (22%) for non-clinical reasons. Altogether 294 (84%) were admitted to intensive care or a high dependency unit at the receiving hospital. The in-hospital documented mortality rate was 26%. A total of 170 patients (49%) had traumatic pathology of which 101 were principally transferred for management of a head injury. Median time in the ED was 3 hours 5 minutes (range 11 minutes to 17 hours 47 minutes). In 146 (42%) patients the decision to transfer was primarily made by the emergency medicine clinician. A total of 251 (72%) patients were intubated. The documented critical incident rate was 15%. Conclusion: Trauma is the most common reason for transfer of the critically ill adult from the ED. A significant number of patients are transferred, however, with medical and surgical conditions and for nonclinical reasons. There continues to be problems with the quality of care that these patients receive. Emergency medicine clinicians must be actively involved in the development of regional critical care systems as a significant proportion of all critically ill adults transferred originate from the ED.T he inherent problems with the organisation and process of the transfer of the critically ill and injured are well recognised by emergency medicine clinicians within the United Kingdom. Previous publications have highlighted the deficiencies in the quality of care received during the transfer of the critically ill and injured adult. 1-3A system-wide approach has been suggested for trauma 4 and more recently by the Department of Health in the document Comprehensive critical care 5 for the critically ill adult. This document defines areas within critical care practice that need improvement. Specifically, the organisation of transfers of the critically ill, the quality of care, and the associated training of the staff involved have been highlighted. Problems with quality of care have been attributed to inadequate monitoring, 6 junior accompanying medical staff, 1 and poor pretransfer stabilisation.2 7-9 Attempts have been made to improve standards and training by providing specific training courses 10 and by developing clinical guidelines. [11][12][13] Despite this little is known about the descriptive epidemiology of this group of patients particularly those transferred from the emerge...

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Section: Discussionmentioning

confidence: 99%

Descriptive epidemiology of adult critical care transfers from the emergency department

Gray

Gill²,

Airey³

et al. 2003

Emergency Medicine Journal

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“…Moreover, transport vehicles are not conducive to carrying out active interventions on patients,15 although such events may frequently arise during transport 21. Critical incidents involving patients requiring intervention range from 15%22 to 41%;7 equipment failure has a significant reported incidence of 4.4% 7…”

Section: Discussionmentioning

confidence: 99%

“…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…”

mentioning

confidence: 99%

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

Ahmed

Majeed

2008

Emergency Medicine Journal

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“…Undertreated or neglected injuries can adversely affect outcome, as can the lack of anticipation of potential cardiovascular or respiratory problems. [6][7][8][9][10][11][12] For many patients, longer pre-transfer times will not adversely affect outcome 13 14 and pretransfer optimisation may be beneficial. However, delays may be harmful to certain groups (eg, patients with a ruptured abdominal aortic aneurysm or expanding intracranial haematoma).…”

Section: Questionmentioning

confidence: 99%