Descriptive epidemiology of adult critical care transfers from the emergency department

Abstract

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...

Comparison of access to services in rural emergency departments in Quebec and British Columbia

“…12 The transfer for critical care patients has in itself been implicated in contributing to poor outcomes. 23,30 Could the development of formalized training programs in critical care for general practitioners be a solution minimizing interfacility transfers and ICU coverage gaps in rural areas? A program akin to the College of Family Physicians of Canada training in emergency medicine (CCFP-EM) may be of interest.…”

Republished paper: The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review

“…Several other papers identify problems with the care of patients being transferred, particularly as transfers often take place out of hours51 and vital equipment may not be available 52. The NCEPOD trauma audit described arrangements for transfers as ‘haphazard,’ with deficiencies in local protocols, use of national guidelines, consultant oversight and documentation 34…”

Traslado aéreo de un paciente con insuficiencia cardíaca conectado a ECMO

“…El trasporte inter-hospital es utilizado cuando la capacidad diagnóstica o terapéutica del hospital de origen es limitada 7 . La regionalización de unidades mejor equipadas a lo largo de los países ha contribuido a la utilización cada vez más frecuente de los traslados inter-hospitalarios 8 .…”