Patent Transfer from Hospital

Patent Transfer from Hospital

Introduction

Transfer of critically ill patients within a hospital is often necessary but can be associated with an increased risk of morbidity and mortality. Due to changing roles, nursing staff are commonly finding themselves responsible for transferring patients. This article outlines the issues involved in ensuring patient transfer is undertaken both safely and effectively.

The intra-hospital transfer of patients is recognised as a procedure that is fraught with complications and therefore requires careful planning and organisation. Although patients may derive significant benefit from such a transfer, there are also potential risks involved. The decision to initiate the transfer of any patient must therefore be taken with full consideration of the risks and benefits.

The risks

The Resuscitation Council (2004) gives clear instructions for transferring patients. The potential problem areas are:

The equipment used for transferring the patient;

The organisation of the transfer;

The level of experience of the nurse transferring the patient;

The level of training of the staff within the department receiving the critically ill patient.

Waydas (1999) identifies critically ill patients as being at risk during intra-hospital transfer. However, careful planning, appropriately qualified personnel and use of the correct equipment can reduce this risk. Inadequately organised transfers can ultimately go wrong, leaving the nurse feeling both angry and disappointed - but also partly responsible. Good practice to minimise this would be the provision of guidance from the trust or employer in relation to the patient transfer.

 

Equipment

Most patients who are being considered for transfer will be having their vital functions closely monitored with regular blood pressure, pulse and oxygen saturations being recorded. During transfer these are not always continuously monitored. However, most guidelines suggest a minimum level of monitoring is essential for the safe transfer of patients. The Intensive Care Society (2002) recommends that the minimum number of checks should include:

Blood pressure (acknowledging the limitation of non-invasive monitoring);

Electrocardiography;

Pulse oximetry;

Temperature;

End-tidal CO2 (in patients who are intubated).

There are a variety of devices available commercially to allow accurate monitoring and observation of patients during transfer. To ensure that the appropriate device is selected, trials should be carried out.

Regardless of the device selected, training sessions will need to be organised to facilitate safe and appropriate use of the equipment.

The ideal would be to have appropriate equipment available at all times for transferring patients, as identified by the Department of Health's clinical practice benchmarks (Baker, ...