Core Topics in Critical Care Medicine: Transfer of the critically ill

Introduction It is estimated that in excess of 10 000 critically ill or injured patients are transferred between hospitals each year in the UK. Special consideration to the risks and benefits of patient transfer is required. Transfers often take place out of routine working hours, with relatively junior medical staff, and are often associated with a high level of adverse/critical incidents. These factors may contribute to the increased risk of morbidity and mortality faced by patients requiring a critical care transfer. Transfers can be divided into primary or secondary transfers. A primary transfer, from the site where a patient sustains their injury or illness, is normally undertaken by the Ambulance Service in the UK. Occasionally these transfers may be supported by doctors from the local ambulance service or pre-hospital medical care scheme (e.g. BASICS). The main involvement of anaesthetists, emergency physicians, intensivists and other acute speciality staff are in secondary transfers. These include both intra-hospital transfers (e.g. between emergency department and critical care unit or to/from a CT scanner) and inter-hospital transfers. The requirements in terms of planning and ensuring the correct equipment and personnel accompany the patient are similar whether the patient is being transferred within or between hospitals. This chapter will focus predominantly on inter-hospital transfers, but the principles are equally relevant to intra-hospital transfers.