Safe Transfer and Retrieval (STaR) of Patients

The Practical Approach

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• Publisher: BMJ Books
• Year: 2017
• ISBN:
  9781118289259
• Edition: 2
• Topic: Medicine
• Subtopic: Emergency Medicine & Critical Care

The safe transfer of all hospital patients, especially those who are critically ill, is of crucial importance, demanding organisational, as well as clinical skills.

Safe Transfer and Retrieval of Patients (STaR) is aimed at all health care workers involved with inter and intra-hospital transfers. It provides a much needed structured approach to transfer medicine, together with sound guidance on relevant clinical procedures.

The second edition has been extensively revised in line with new developments in transfer medicine. The book has been redesigned with five distinct sections covering:

• the principles of the STaR structured approach to transfers
• the management of the transfer or retrieval
• practical procedures related to transfer medicine
• an overview of clinical care during the assessment and stabilisation phases of transfer.
• the legal and safety aspects of transfers, specific differences in helicopter transfers and transfers involving children

A new chapter, the infectious or contaminated patient, has been added, in light of current concerns around the potential transfer of infection between patients and staff.

The major revisions to this STaR coursebook bring it into line with the latest thinking on patient transfers, making it an invaluable guide for anyone involved in this aspect of health care.

PART I
Introduction

Chapter 1
Introduction

This book and its associated course are aimed at a multi-disciplinary audience and have been developed in an attempt to overcome the difficulties faced by all healthcare professionals when organising and carrying out the transfer of patients who may be critically ill or injured. There are essentially two components:

1. Organisational and management strategy
2. Practical problems that may be encountered during preparation, packaging and transportation of patients

Although the Safe Transfer and Retrieval (STaR) course focuses on transportation of patients between hospitals, the same approach should be applied to the transportation of any ill patients within hospitals.

In recent years, following concerns about the standard of head injury transfers, there has been a great deal of interest in improving the standards for the care of the critically ill who are transferred between hospitals.

In 1996, a multi-professional group from across the UK first met to devise a training system aimed at promoting a structured approach to the transfer of the critically ill. The vision was, and still is, that, in the same way that everybody now accepts the systematic ABCDE approach to resuscitation, healthcare professionals would adopt ACCEPT as the basis for a structured approach to transfer medicine.

In 1997 the Intensive Care Society (ICS) published its Guidelines for the Transport of the Critically Ill Adult; these were revised in 2002.

Safe Transfer and Retrieval: The Practical Approach was first published in 2002 as the core text for the STaR course.

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Box 1.1 Primary diagnosis in transferred patients

Trauma (including head injuries)

Respiratory failure/pneumonia

Post-operative/surgical

Intracranial bleeds/subarachnoids

Post-cardiac/respiratory arrest

Overdose

Renal failure

Multi-organ failure/sepsis

Liver failure

Pancreatitis

Burns

Aortic aneurysm

Cardiac failure

Others:

• Asthma
• Neurological condition
• Status epilepticus
• Meningitis
• Diabetes
• Cancer
• Eclampsia

Source: Intensive Care Bed Information Service (ICBIS)

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The number of inter-hospital transfers continues to rise. This increasing demand for intensive care beds is fuelled by patients’ and relatives’ expectations and improved resuscitation and surgical techniques.

In most cases, an Intensive Care transfer results from the lack of a functioning ICU bed in the primary hospital. This could be due to lack of either an available bed or the nursing staff to look after the patient. The second most common cause is the requirement for specialist management in a tertiary centre. Box 1.1 demonstrates the wide spectrum of clinical pathologies which may be encountered.

The source of these patients also varies widely (Box 1.2). Emergency Departments and ICUs are the most frequent starting places for the movementof intensive care patients.

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Box 1.2 Transferring departments

Emergency Department

ICU

Theatre

Ward

HDU

CCU

Source: Intensive Care Bed Information Service (ICBIS)

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Though it is to be expected that patients moving from ICU will be fully stabilised and packaged, the same assumption cannot be made when patients are moved from other departments. These patients, and those coming from wards and theatres, may require considerable time before they are adequately prepared and packaged for transfer.

Inter-hospital transfers are not infrequently associated with adverse events which may be recorded on transfer forms or spotted by independent auditors. Those reported most commonly are shown in Box 1.3.

Although the ICS guidelines and the STaR course were initially aimed at improving the care delivered to critically ill patients, it seems that there are an increasingly large number of ‘high dependency’ patients whose transfers are less than ideal. It therefore seems logical to extend the concepts of Safe Transfer and Retrieval to encompass a wider spectrum of patients.

Furthermore, recent published work has highlighted that transfers within hospitals (intra-hospital transfer) are a cause for concern. Although this Australian study looked at reported incidents around the intra-hospital transfer of critically ill patients, there are lessons to be learned by all who transfer less seriously ill patients within hospitals. Of the reported incidents, 39% identified equipment problems, relating predominantly to battery/power supply, transport ventilator or monitor function. Also in this group, access to lifts was a significant problem. More than half (61%) of the reported incidents related to staff issues in which communication and liaison problems were highlighted.

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Box 1.3 Most commonly reported adverse events

• No capnography available (when clinically indicated, with potential for raised ICP)
• Cardiovascular instability during transfer
  • Tachyarrythmias/bradycardias
  • Hypotension
  • Hypertension

• Hospital equipment problems
  • Monitor failure
  • Pump failure
  • Equipment not available
  • Mechanical ventilator not available

• Significant hypoxia
• Ambulance breakdown/lost en route
• Cardiac arrest in ambulance
• Death in transfer

Source: Intensive Care Bed Information Service (ICBIS)

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The 2006 edition of Safe Transfer and Retrieval: The Practical Approach, the core text for the STaR course, has been redesigned in order to make the concept of a structured approach to transfers more widely available to healthcare professionals of all disciplines throughout hospitals.

The move towards competency-based medical education and the devel...

Table of contents

• Cover
• Title Page
• Copyright
• Working groups
• Contributors
• Preface to the second edition
• Preface to the first edition
• Acknowledgements
• Contact details and website information
• PART I: Introduction
• PART II: Managing the transfer
• PART III: Practical aspects of transfer medicine
• PART IV: Assessment and clinical aspects of transfer medicine
• PART V: Special considerations
• PART VI: Appendices
• References and further information
• Glossary
• Index
• EULA