ABSTRACT
Introduction: Retrieve is the South West's dedicated Adult Critical Care Transfer Service (ACCTS), commissioned to meet the needs of the COVID-19 pandemic and build a permanent legacy for the region's critical care patients. The South West Critical Care Network (SWCCN) has long had an interest in critical care transfer and in 2020, published a retrospective analysis of its transfer activity.1 Whilst there were limitations of the data, it identified a clear need for a transfer service in terms of activity and the need to improve the consistency and quality of transfer care. Retrieve launched on 2 November 2020 and undertakes all types of critical care transfer, from time-critical and urgent escalations of care to repatriations and capacity transfers. It operates two consultant-led clinical teams 12 hours a day. As a fully digital service, it has collected data about every referral and transfer since then. This dataset is essential in informing the ongoing development of Retrieve as well as other ACCTS across England. Objectives: To describe the first 500 transfers undertaken by the Retrieve ACCTS and compare this to existing regional data. Methods: Using the Retrieve electronic patient record and database system, the first 500 transfers that the service undertook were identified and an anonymised dataset downloaded. This data was categorised by type of transfer, time of day, referring and receiving hospitals, patient demographics, referring clinician and specialty. Results: The first 500 transfers by Retrieve were completed in 258 days, with 161 (32%) being undertaken by the Peninsula team and 339 (68%) by the Severn team. Sixty one percent of transfers (303)were escalations of care to specialist centres, of which 1 in 3 were classified as 'time critical'. The service undertook 87 repatriations (17% of work). Capacity transfers (previously called 'non-clinical transfers') comprised 22% of transfers (110), including interregional mutual aid work undertaken as part of the COVID-19 wave 2 in January and February 2021. Comparing the data to SWCCN published work, a smaller proportion of transfers were for escalation of care (61% vs 83.2%) and a higher proportion of repatriations (17% vs 10.5%). Conclusion: The Retrieve data provides valuable insight into the work of a new dedicated ACCTS and is helpful in informing future development regionally and nationally. The reasons for transfer are similar to published data1 but are skewed by the capacity transfer work generated by the COVID-19 pandemic as well as a strict adherence to database definitions and data integrity. This data should provide reassurance to those involved in ACCTS development across England that the workload and approximately breakdown of types of transfer matches that which has been anticipated.
ABSTRACT
Introduction: Retrieve, the South West's dedicated Adult Critical Care Transfer Service (ACCTS), went live on 2 November 2020. As one of the first ACCTS in the country, every element of Retrieve's operational and clinical service had to be developed from scratch. Within two months of going live, the service was asked to rapidly expand its service provision to meet the demands of the pandemic. The Transfer Practitioner (TP) training proved to be an essential component of the service's ability to deliver this. Retrieve transfers are performed by a Duty Consultant and a TP operating from bases in Cornwall and Bristol. Along with a core leadership team, the twelve newly appointed full-time TPs, all experienced critical care nurses, became essential to the day-to-day delivery of a high quality, safe, service and were a continuous presence at a time of rapid temporary clinician influx. Objectives: The objective of the TP induction program was to create a cohort of highly trained practitioners who could guide the delivery of a high-quality service even during times of rapid expansion. This induction program was novel and had to be delivered across the challenging geography of the South West region. Commissioned, developed and launched during the COVID-19 pandemic, Retrieve's service design needed to be scalable, flexible and agile, during a time of remarkably challenging operational pressure. Methods: The induction program was developed and led by the Retrieve Base Lead Nurses and was delivered by a multidisciplinary faculty across two base locations, including face-to-face and virtual sessions. Presentations on a variety of clinical transfer-specific topics as well as Retrieve governance and SOP's. The sessions included small group teaching, equipment familiarisation and a modified Neonatal, Adult and Paediatric Safe Transfer and Retrieval (NAPSTaR) course. The program concluded with the two teams coming together at NHS Nightingale Hospital Bristol for two days of simulation scenarios in a Covid-19 safe manner. Results: The induction program established and promoted team cohesion. Created a safe space to learn new techniques and ensured the service had an agile and flexible workforce. Within two months of launch, Retrieve was able to double in size within days of the NHS England instruction to provide additional capacity and capability. Secondary to the success of induction, with TPs a continuous presence for each transfer, Retrieve was able to rapidly onboard forty 'surge doctors' helping to provide high-quality transfers. Undertaking both business as usual and a large number of regional and inter-regional capacity transfers, including 100% of regional capacity transfers.1 Conclusion: The induction was a key component of how Retrieve was able to establish a solid foundation. The transfer practitioners have key buy-in, are engaged in service development and improvement, and take pride in being part of a novel service. Developing a service during a period of such operational pressure has been challenging, but implementing a considered, systematic, team-focused, equitable induction program was one element of how Retrieve became an agile and flexible service, responsive to providing additional capacity when required.