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Critical Care

Principles of safe inter-hospital transfer of critically unwell adults

13 August 2024
Clinical
02 August 2024
Volume 33 · Issue 15

Abstract

The purpose of this article is to explore the key themes and safety considerations connected to the inter-hospital transfer of critically unwell adults. First, the evidence base surrounding the subject is critically explored and clinical guidelines and national policy are discussed. Second, safety considerations are explored that highlight the risks and challenges associated with the inter-hospital transfer of critically unwell people.

The nature of critical care means that adults admitted to such units will be critically unwell and experiencing organ dysfunction or other life-threatening conditions (Jackson and Cairns, 2021). Higher staffing ratios on critical care units, specialised equipment and advanced monitoring aim to reduce morbidity and mortality in people experiencing critical illness. On occasion, a patient will require care that is unavailable at the hospital and the decision to transfer a critically unwell adult to another care facility should be planned, risk assessed and appropriately resourced.

There are significant risks associated with the inter-hospital transfer of critically unwell adults (Dabija et al, 2021). Mueller et al (2019) suggested the practice of inter-hospital transfer varies and is non-standardised, which contributes to poor clinical outcomes, including longer hospitalisation and a higher risk of mortality.

The Intensive Care Society (ICS) (2021) has outlined the levels of care a person requires, according to their condition:

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Inter-hospital transfer
Critically unwell adult
Patient safety
Risk
Critical care