Learning from critical care: Improving intra- and inter-hospital transfer processes in enhanced care and the ward.

The Intensive Care Society (ICS) has recently published guidance on the transfer of critically ill adults. Since 2007, the North West London Critical Care Network has documented and audited patient transfers undertaken across 13 hospitals, and trained staff in transferring critically ill or injured patients. In 2015/16 the network introduced intra-hospital transfer documentation and applied the same transfer training and audit methodology for critically ill patients being moved within hospitals. While increasing data capture and with a targeted training strategy adapted from transfer experience, the network has seen a reduction in number and severity of incidents in the region. In contrast to this experience, no formalised processes exists to support the inter-hospital or intra-hospital transfer of patients from enhanced care areas or wards not embedded within critical care. Often very little data is collected from these areas, but we suspect transfer risks are higher in these cases as a consequence of the deficit of structured transfers. In collaboration with members of the critical care network, we have developed a basic training module along with the use of a transfer form which has been well received and had a positive impact in terms of incidents reported.

A consensus to determine the ideal critical care transfer bag.

BACKGROUND: Familiarity with environment, processes and equipment reduces the risk inherently associated with critical care transfers. Therefore, the North West London Critical Care Network decided to create a standardised ideal transfer bag and contents to improve patient safety. METHODS: A four-round modified Delphi survey developed a condensed and clinically tested content list. An expert panel then designed an ideal transfer bag based on agreed important principles. RESULTS: Participants completed two rounds of an electronic survey. Round 3 comprised an expert clinical panel review, while round 4 tested the contents over 50 clinical transfers. The prototype bag's design was adjusted after clinical use and feedback. DISCUSSION: This project has introduced a standardised critical care transfer bag across our network. A similar technique could be used for other healthcare regions. Alternatively, the above critical care transfer bag could be adopted or adapted for regional use by clinicians.