When place and time matter: How to conduct safe inter-hospital transfer of patients

Abstract

Inter-hospital transfer (IHT) of patients is often needed for diagnostic or therapeutic interventions. However, the transfer process carries its own risks as a poorly and hastily conducted transfer could lead to adverse events. In this article, we have reviewed literature on the key elements of IHT process including pre-transfer patient stabilization. We have also discussed various modes of transfer, physiological effects of transfer, possible adverse events and how to avoid or mitigate these. Even critically ill-patients can be transported safely by experienced and trained personnel using appropriate equipment. The patient must be maximally stabilized prior to transfer though complete optimization may be possible only at the receiving hospital. Ground or air transport may be employed depending on the urgency, feasibility and availability. Meticulous pre-transfer check and adherence to standard protocols during the transfer will help keep the entire process smooth and event free. The transport team should be trained to anticipate and manage any possible adverse events, medical or technical, during the transfer. Coordination between the referring and receiving hospitals would facilitate prompt transfer to the definitive destination avoiding delay at the emergency or casualty. Documentation of the transfer process and transfer of medical record and investigation reports are important for maintaining continuity of medical care and for medico-legal purposes.

Multilevel social spaces: The network dynamics of organizational fields

“…An interhospital patient transfer occurs when a patient discharged from one ("sender") hospital is admitted to another ("receiver") hospital in the same calendar day. Inter-hospital patient transfers are an essential component of health care systems (Sethi & Subramanian, 2014). Proliferation of specialties and regionalization of specialized care have contributed to an increase in inter-hospital patient transfers (Wagner et al, 2013).…”

Inter-hospital transport of critically ill patients: the reality of a hospital in the Northeast region of Portugal

“…These results are contrary to those found in this study, where respiratory diseases appear in fifth place. Septic shock was the most common diagnosis reported by Sethi and Subramanian (2014). This difference in results may be associated with the response capacity of the Intensive Care Unit of the Hospital Unit of Bragança to treat patients with immunological/infectious and respiratory diseases, not needing to transfer them.…”

“…International studies (Etxebarría et al, 1998;Kulshrestha & Singh, 2016) have documented the risk inherent to patient transport. Sethi and Subramanian (2014) have concluded that patients with a risk score ≥7 are at high risk for critical events and subsequent mortality. In this case, continuity of care should be maintained during the inter-hospital transport, and the team must be trained and qualified to anticipate, manage, and resolve any technical and medical difficulties that may arise during transport.…”

Investigating the Temporal Dynamics of Interorganizational Exchange: Patient Transfers among Italian Hospitals

“…Inter-hospital patient transfers are an integral component of the Italian health care system, and of health care institutions more generally (Sethi and Subramanian, 2014). Over the last decades the health care literature has devoted increasing attention to patient transfers by focusing not only on their associated costs and clinical risks, but also on the critical role they play in ensuring the best possible care to patients (Hains et al, 2011).…”