Transferring patients can be a difficult process fraught with risk. There are many things that need to be taken into account in order to ensure that the transfer is as smooth as possible. In this article, we will discuss some of the things that need to be considered when transferring patients between hospitals, wards and care settings.
Patient transfers can therefore be viewed as inter-hospital, intra-hospital and inter-institution. Patient transfer basics are always the same:
- Ensure patient safety
- Reduce risk
- Co-ordinate with receiving team
- Set a date and time
- Determine clear benefit for the patient’s care
Why are patients transferred?
The intra- and inter-hospital patient transfer is an important aspect of patient care which is often undertaken to improve upon the existing management of the patient. It may involve transfer of the patient within the same facility for any diagnostic procedure or transfer to another facility with more advanced care.
The main aim in all such transfers is maintaining the continuity and efficacy of medical care. As the transfer of a sick patient may induce various physiological alterations which may adversely affect the prognosis of the patient, it should be initiated systematically and be evidence-based.
Existing UK guidelines for patient transfers
There are a number of existing guidelines that cover patient transfers between healthcare settings. These include:
- The NHS Interhospital Transfers Guidance (2017)
- The Department of Health’s ‘Good practice in inter-hospital transfer’ (2010)
- The National Institute for Health and Care Excellence’s ‘Inter-hospital transfers of adults with acute medical conditions’ (2014)
These guidelines set out the standards that should be met when transferring patients between healthcare settings. They cover a range of topics, including patient safety, communication and the process of transfer itself.
By following these guidelines, we can ensure that all patients are treated safely and effectively during the transfer process.
Current Guidelines Overview
The NHS Interhospital Transfers Guidance (2017) is a document that provides healthcare professionals with advice on how to best transfer patients between hospitals. The guidance covers a range of topics, including the preparation of patients for transfer, the use of transport services, and the management of transfers between hospitals.
The Department of Health’s ‘Good practice in inter-hospital transfer’ (2010) summarises the key good practice recommendations for safe and effective patient transfers between healthcare organisations. The recommendations are based on evidence and best practice from healthcare organisations across the UK.
The key recommendations are as follows:
1. All healthcare organisations involved in a patient transfer should have a transfer agreement in place. This agreement should outline the roles and responsibilities of each organisation, as well as the process for transferring patients.
2. The receiving healthcare organisation should always be prepared to receive patients, with appropriate staffing and equipment in place.
3. Patients should only be transferred when it is clinically safe to do so. Factors that should be considered include the patient’s condition, the distance between healthcare organisations, and the availability of transport.
4. The transport of patients should be planned and co-ordinated by a healthcare professional with expertise in transport logistics.
5. Patient transfers should be monitored and reviewed regularly to ensure that they are safe and effective.
The National Institute for Health and Care Excellence’s ‘Inter-hospital transfers of adults with acute medical conditions’ (2014) provides guidance for healthcare professionals on the safe and effective transfer of adults with acute medical conditions between hospitals. The guidance covers topics such as planning and preparing for a transfer, the use of specialist transport services, and the management of patients during transport.
Why do we transfer patients between wards?
There are a number of reasons why patients may be transferred between wards in a healthcare setting. Some of the most common reasons include:
- To provide the patient with the best possible care, based on their current condition
- To allow them to receive specialist treatment or care that is not available on their current ward
- To free up bed space on a busy ward
- To allow them to recover in a more comfortable environment
Whatever the reason for the transfer, healthcare professionals need to make sure that the process is carried out smoothly and with minimal disruption to the patient’s care.
Patient centred inter-hospital transfer
The use of transfer checklists are widespread in modern clinical settings. By adhering to a repeatable set of instructions risk is minimised and appropriate parties remain informed with up to date information.
From a patient-centred perspective:
Firstly, it is important to check that the patient is happy with the move and that they understand why it is happening. If they have any concerns, try to address them before proceeding.
- Make sure you have all the necessary paperwork in order, including any consent forms that may be required. This helps avoid delays in treatment and the patient having to repeat themselves. Patient repetition to different clinicians gives a negative impression of a disconnected and non-communicative workforce.
- Once everything is in order, it is time to move the patient to their new ward. Make sure appropriate members of staff are with you if the patient requires medical supervision during transfer.
- Finally, take care to ensure that the patient is comfortable and settled in their new surroundings.
By following these simple tips, you can help make the process of transferring patients between wards as smooth and stress-free as possible.
Critically ill patients
Critically ill patients require special care and attention, which is why when they need to be transferred between hospitals, it is a process that must be done with caution. In order to ensure the safety of the patient, a number of measures are put in place.
One of the most important aspects of transferring a critically ill patient is making sure that they are accompanied by a healthcare professional who is familiar with their condition and is able to act in case of deterioration. This ensures that if there are any problems during the transfer, the healthcare professional can take appropriate action.
Another key factor in transferring a critically ill patient is making sure that all the necessary equipment is available. This includes things like ventilators and cardiac monitors, as well as supplies like blood and medication.
Patient physiological alterations during transport are changes in oxygen levels, blood pressure, heart rate and intracranial pressure. These changes can be significant and can lead to instability in critically ill patients.
It is important that healthcare professionals are aware of these changes and take steps to minimise them. This includes using oxygen therapy, maintaining blood pressure and heart rate, and avoiding sudden changes in position.
The transportation of a critically ill patient can be a complicated process, but by taking the necessary precautions, it can be safely carried out.
When transferring critically ill patients, healthcare professionals should utilise checklists as they need to take into account a number of factors. These should include:
- The patient’s health history and current condition
- The destination ward’s speciality and level of care
- Whether the patient requires specialist equipment or medication
- How long the transfer will take
- Confirmation from the receiving team that they are able to take the patient
Ensuring Patient comfort
Transferring patients can be a stressful experience, both for the patient and their family. In times of increased demand, the number of logitical transfers increase, placing added stress to the system and patients. Healthcare professionals need to take steps to ensure that the patient is as comfortable as possible during the transfer process. This may include:
- Providing them with a pillow and blanket for the journey
- Making sure they have all their belongings with them
- Assisting them with any personal care needs they may have
- Reassuring them throughout the process
Intra hospital communication
Healthcare is a complex and demanding field, and it is essential that healthcare professionals are able to communicate effectively with one another in order to provide the best possible care for their patients.
Good communication allows nurses, doctors and other healthcare professionals to share information quickly and easily, which can be vital in a hospital setting where decisions need to be made swiftly. It also helps create a positive working environment, which is important in such a high-stress environment.
Hospitals can be chaotic places, and effective communication is one way of ensuring that everyone is aware of what is happening and that patients receive the best possible care.
But how do we ensure good communication between hospitals?
One way to ensure good communication between hospitals is by using a healthcare information system (HIS) that has evolved beyond a simple electronic healthcare record (EHR). A HIS can help healthcare providers share patient information quickly and easily, ensuring continuity of care.
For this to work however, there needs to be interoperability between whichever two systems each institution uses. The transfer of patient information needs to be complete, easy to review and inform the new team of recent events and the forward view of the patient.
Transporting critically ill patients to a hospital
Patients requiring critical care are often transferred between hospitals for a variety of reasons
While the decision to transfer a patient should be made in consultation with the receiving hospital, there are a number of factors that need to be considered prior to transport. These include the patient’s current condition and drug therapy, as well as the potential risks posed by acceleration, deceleration and flying at altitude.
Patients should be stabilised first to minimise the risk of instability during transfer. This may involve reducing the patient’s drug therapy or providing additional support, such as intubation and mechanical ventilation. Once stabilised, the patient can be transferred using a variety of methods, including road, rail or air transport.
Potential Systemic Effects of Transport
Physiological consequences of acceleration
Cardiovascular system:
In critical illness, the baroreceptor reflex may be significantly reduced or absent, leading to a decrease in venous return and cardiac output, and hypotension. This hypotension can be exacerbated by hypovolemia and positive pressure ventilation, both of which reduce preload. To compensate for this, increased inotropic and vasopressor support may be required.
Neurological system:
Healthcare professionals must be aware of how to properly maintain a patient’s cerebral perfusion pressure. This is important in cases of head injuries, as a decrease in cerebral perfusion pressure can lead to a decline in the patient’s conscious level. Mean arterial pressure (MAP) and intracranial pressure (ICP) must be carefully monitored in order to keep cerebral perfusion pressure (CPP) within a safe range.
Physiological consequences of deceleration:
Cardiovascular system:
Venous return will be increased due to the inertial forces, which can lead to cardiac failure, pulmonary oedema, and arrhythmias in patients with cardiac impairment.
Neurological system:
As a result of the displacement of venous blood and cerebrospinal fluid, the intracranial pressure (ICP) increases. This is especially concerning in patients who already have a high ICP, as their cerebral perfusion may be further compromised during transport.
Gastrointestinal system:
There is potential for increased risk of aspiration when transferring patients, especially those with gastrointestinal issues. This is due to the displacement of the stomach towards the patient’s head, which can increase pressure on the diaphragm and reduce tidal volumes.
Intertial forces can move stomach contents towards the head and push past the cardia of the stomach.
Musculoskeletal system:
Take special precautions when transferring patients, especially those with spinal injuries, as the inertial force can cause displacement of unstable fractures.
Equipment
It is important to note that these forces also apply to equipment and medical personnel.
The forces that are applied to equipment and medical personnel also apply to healthcare. This is why it is important to secure equipment and have all medical personnel sit down with a seat belt during ambulance movement. This will help reduce the risk of injury. Medical staff are less affected physiologically due to having compensatory mechanisms intact, and the direction of inertia acting in the anterior posterior direction because of their seated position.
There are also static hazards that can have a significant effect on patients, these include:
Noise
Affecting both communication between medical staff as well as patients, noise is hard to manage and can cause distress especially if the patient is in pain or confused.
Temperature
Transferring a patient between healthcare facilities can be risky, as the patient is exposed to a range of temperatures that can cause hypo and hyperthermia. It is therefore important to monitor a patient’s temperature closely during transfer and take steps to prevent them from becoming too cold or too hot.
Duration
Pressure areas need to be protected and monitored during long transfers, especially if the patient is receiving vasopressor therapy. This is because blood and other bodily fluids can pool in dependent parts of the body, which can lead to tissue maceration and the development of pressure sores. In addition, using an extrication board for a prolonged transfer can cause pressure sores to develop on the patient’s skin. For this reason, healthcare professionals should use a vacuum mattress whenever possible during transfers.
