A survey of secondary transfers of head injured patients in the south of England

Vyvyan, H.A.L.; Kee, Spencer Stephen; Bristow, Aubrey

doi:10.1111/j.1365-2044.1991.tb09766.x

Cited by 18 publications

(9 citation statements)

References 11 publications

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“…A number of reasons have been suggested for the delay in transfer. 11 Our results indicate the largest part of the delay is due to time spent in the referring hospital-a consistent finding in the literature. 5,12,13 Previous studies have looked at timing and outcome for extradural, acute subdural and intracerebral haematoma separately.…”

Section: Discussionsupporting

confidence: 87%

Is the recommended target of 4 hours from head injury to emergency craniotomy achievable?

Sergides

Whiting

Howarth

et al. 2006

British Journal of Neurosurgery

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Guidelines recommend that head-injured patients who require life-saving decompressive surgery should undergo surgery within 4 h. To assess the compliance with this recommendation 100 consecutive head-injured patients admitted to a regional neurosurgical unit (RNU) were studied. Time points from head injury to craniotomy were documented and analysed. Twenty-four patients underwent emergency craniotomy, only one being operated on within 4 h. In this cohort of patients there was no relationship between timing of surgery and outcome. In order to investigate whether it is possible to reduce delays in transportation time, theoretical models were created to determine whether direct transfer to the RNU would be faster by land or air ambulance.

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Section: Discussionsupporting

confidence: 87%

Is the recommended target of 4 hours from head injury to emergency craniotomy achievable?

Sergides

Whiting

Howarth

et al. 2006

British Journal of Neurosurgery

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“…It is of concern, however, that 76 (22%) of patients were transferred for non-clinical reasons such as the unavailability of a staffed critical care bed at the referring hospital. This is alarming given recent recommendations suggesting that if non-clinical transfers must happen then the patient transferred should be the most stable patient requiring critical care 6 within the hospital at that time. This is unlikely to be the case for ED patients as they are early in their pathway of care and likely to be at their most clinically labile.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] These studies were undertaken using questionnaires or cases series with small patient numbers often into a single specialist department and, therefore, are more likely to have inherent flaws in their results.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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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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“…20-24 They should be accompanied by an anaesthetist or a doctor who is adept at handling ventilated patients16 as recommended by all the neurosurgical units in this study. Intensive hyperventilation (PaCO 2 <4 kPa) was advocated by almost a third of surgeons for patients 1 and 3, despite published guidelines 20.…”

Section: Discussionmentioning

confidence: 99%

Snapshot view of emergency neurosurgical head injury care in Great Britain and Ireland

Crimmins

2000

Journal of Neurology, Neurosurgery &Amp; Psychiatry

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Objectives-To study the availability of neurosurgical intensive care for the traumatically brain injured in all 36 neurosurgical centres in the United Kingdom and Ireland receiving head injuries, the response times to referral, and the advice given to the referring hospitals. Methods-Telephone survey of receiving neurosurgeons regarding their bed status and their advice on three hypothetical case scenarios. Outcome measures included response times for an acute head injury to be accepted to a neurosurgical centre; the intensive care bed status; variations in advice given to the referring hospitals with regard to ventilation, use of mannitol, steroids, anticonvulsants, and antibiotics. Results-There were 43 neurosurgical intensive care beds available for an overall estimated population of 63.6 million. There were 1.8 beds available/ million of the population for nonventilated patients, 0.64 beds available/ million for ventilated patients, and 0.55 beds available/million for ventilated paediatric patients. London had a shortage of beds with 0.19 adult beds for ventilation/ million north of the Thames and 0.14 adult beds for ventilation/million south of the Thames. The median response time for a patient with an extradural haematoma to be accepted for transfer was 6 minutes and 89% of such a referral was accepted within 30 minutes. Clinically significant delays in receiving referrals (over 30 minutes) occurred in four units. Practices regarding the use of hyperventilation, mannitol, anticonvulsants, and antibiotics showed little conformity and in some cases were against the available evidence and advice given by published guidelines. Conclusions-There is a severe shortage of available emergency neurosurgical beds especially in the south east of England. The lack of immediately available neurosurgical intensive care beds results in delays of transfer that could adversely aVect the outcome of surgery for traumatic intracranial haematoma. Advice given to the referring units by the receiving doctors is very variable. (J Neurol Neurosurg Psychiatry 2000;68:8-13)

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A survey of secondary transfers of head injured patients in the south of England

Cited by 18 publications

References 11 publications

Is the recommended target of 4 hours from head injury to emergency craniotomy achievable?

Is the recommended target of 4 hours from head injury to emergency craniotomy achievable?

Descriptive epidemiology of adult critical care transfers from the emergency department

Snapshot view of emergency neurosurgical head injury care in Great Britain and Ireland

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