Meeting the standards for interhospital transfer of adults with severe head injury in the United Kingdom

Abstract

In December 1996, the Association of Anaesthetists of Great Britain and Ireland produced a series of recommendations outlining the safe conduct of interhospital transfers for patients with acute head injuries. We assessed the current ability of UK hospitals to implement these recommendations and opinions on the formation of transfer teams, using a postal questionnaire. This was sent to all Royal College of Anaesthetists tutors, 268 of whom replied (94% response rate). Of the hospitals surveyed, 208 received adult head-injury patients but did not have on-site neurosurgical facilities. In 171 (86.8%) of these hospitals, senior house officers could be expected to accompany the patient during subsequent transfer. The majority of hospitals (192, 92.3%) were able to monitor ECG, pulse oximetry and blood pressure during the journey, but only 97 (46.6%) had facilities to monitor end tidal carbon dioxide levels. As a result of the anaesthetist's involvement in the transfer, emergency operating could be delayed in 169 (81.3%) hospitals. One hundred and fifty-eight (76%) respondents thought that the formation of transfer teams to transport critically ill patients would have some merit. Hospitals are responding to the published guidelines, but improvements are still needed in levels of equipment and insurance provision, along with the identification of a designated consultant at each hospital with responsibility for transfers.

Risk management during inter-hospital transfer of critically ill patients: making the journey safe

“…Our results show that only 28% of NHS hospitals provide adequate personal injury insurance to their staff during transfer, which is in agreement with the findings of Knowles et al 8 who reported a figure of 27%. Anaesthetic trainees are encouraged by their consultants to join either the Association of Anaesthesists of Great Britain & Ireland or the Intensive Care Society for additional life and personal injury insurance.…”

“…Most transfer patients are accompanied by junior trainees in anaesthetics, most commonly senior house officers (58%)14 or, in some cases (13%), the accompanying junior staff have <2 years postgraduate experience 8. This is much below the published recommendations,10 – 12 despite the available evidence that transfer by doctors lacking suitable experience may result in a higher incidence of life-threatening complications 20.…”

“…Anaesthetic trainees are encouraged by their consultants to join either the Association of Anaesthesists of Great Britain & Ireland or the Intensive Care Society for additional life and personal injury insurance. However, no such provisions are available for operating department assistants, intensive care and A&E nurses who accompany anaesthetic trainees on 23.5%, 38.4%, and 40% of occasions, respectively 8. We strongly recommend that allied medical staff and nurses involved in inter-hospital transfers should join the Intensive Care Society as membership for non-medical staff is subsidised, to benefit from accident and personal injury cover for up to £1 million during such transfers.…”

“…In the UK, transfer of critically ill patients is continuously evolving and standards continue to improve 8. Critical care networks, transfer groups and retrieval teams have been established in some areas according to national directives 9.…”

Emergency department organisation of critical care transfers in the UK

“…4 Previous publications have suggested that standards of care are suboptimum. [5][6][7] While previous studies have analysed, for example, head injury transfers from an anaesthetic perspective, 8 there is a lack of available data on current levels and standards of transfer specific equipment in UK EDs. Similarly, there is little information on the current organisation and processes of care, staff training systems, and documentation for transportation of the critically ill to and from UK EDs.…”