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Why worry about transfer?

This article discusses the reasons for transferring critically ill patients and emphasizes the importance of understanding and managing the associated risks. It highlights that adverse events are common during transfers and emphasizes the need for proper risk assessment and preparation. The article also elaborates on the various factors that can contribute to risks during patient transfers, including patient condition, equipment and logistics, transport, and the healthcare team. Additionally, it provides guidance on risk assessment techniques and ways to control and mitigate risks during transfers. The article concludes that with careful preparation and knowledge, most adverse events can be avoided during patient transfers.

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Why worry about transfer?

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  1. Why worry about transfer?

  2. Reasons for transferring critically ill patients • Understanding of the risks associated with transfers • Adverse events are common • Risk assessment essential in planning phase • Safer transfers !! Key points

  3. Why move patients? • Primary transfer From pre hospital to a healthcare facility • Secondary transfer From a healthcare facility to a specialised centre

  4. Why move patients? • Intra hospital transfer For imaging (CT, Xray, MRI…) For theatres or interventional radiology Between 2 departments (ward to ICU, ED to ICU) • Capacity transfer Between 2 healthcare facilities when treatment or care not available

  5. Why move patients? • Repatriation From a healthcare facility to another closer to the patient place of residence After specialist treatment After sickness abroad

  6. Why move patients? Whatever type of transfer… …Same principles & same preparation

  7. During transfer…

  8. Why worry… • Risks associated with transfers • Incidents are common • Between 3 and 75% of adverse events reported • 4 categories: • Patient • Equipment & logisitcs • Transport • Team

  9. Why worry… the patient • Main diagnosis… or absence of diagnosis! • Associated medical conditions • Respiratory events: • Desaturation, inadequate ventilation • High airway pressures • Tube dislodgment, sputum mobilisation, chest drain dislodgement • Pneumothorax rare

  10. Why worry… the patient • Cardiovascular events: • Hypo/hypertension, brady/tachycardia, arrhythmias • Haemorrhage, PE • Line kinking, dislodgement • Hypothermia • Transport sickness • Infection control • Relatives

  11. Why worry… the equipment & logisitcs • Ventilator • Monitoring equipment • Volumetric pumps, syringe drivers • Pressure bags • Drugs & Oxygen • Notes • Transport documents

  12. Why worry… the team • Training & experience • Phone • Passport • Money • Jacket • Food, hydration • Motion sickness • Communication

  13. Why worry… the environment • Mode of transport and its crew • Space and its arrangement • Position • Safety • Road traffic collision • Delays

  14. (Why worry… the cost) • Aspect more obvious for repatriation, but also for primary transfer (HEMS) • Very expensive • Travel insurance (read the small lines!!) • Human resources: • Time consuming • Staff(s) away

  15. Risk assessment • Part of our everyday practice! • Answers to four questions: • What can go wrong? • How often? • How bad? • What actions can we take to remove, reduce, ameliorate or mitigate the consequences of the risk?

  16. Risk assessment • Risk matrix: risk from low to extreme From NPSA - Healthcare risk assessment made easy (2007)

  17. Risk assessment • Techniques to control risk: • Risk avoidance: when the consequences are so great that an alternative solution must be found • Risk prevention: by high quality training, protocols and policies, and operating within guidelines and standards • Loss reduction: by reducing the severity of the consequences • Risk transfer: when another organisation takes over the mission • Risk acceptance:

  18. Summary • Transfer is part of the patient’s journey. • Risks associated with transfers. Risk assessment essential. • Adverse events occur between 3 and 75%. • Most adverse events are avoidable with careful preparation and equipment knowledge.

  19. References / links • Intensive Care Society – Guidelines for the transport of the critically ill adult (3rd edition 2011) • ANZCA – Guidelines for transport of critically ill patients (2015) • A. Low and J. Hulmes - ABC of transfer and retrieval medicine (1st edition 2015) • A. Bersten and N. Sony - Oh’s Intensive care manual (7th edition 2014) • T. Martin – Aeromedical transportation, a clinical guide (2nd edition 2006) • T. Martin - Minimising clinical risk – Waypoint, armed and rescue magazine (2011)

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