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National standard operating procedure for inter-hospital critical care transfers/ repatriations where the patient care need is primarily for critical care (NCD19-042/03.08.2021)

• Background

• Standard operating procedure for inter-hospital transfers/ repatriations primarily for ICU care

Background

For a critically ill patient, access to a critical care bed is life-saving. However, critical care beds are scarce - Ireland has one of the lowest numbers of ICU beds per 100,000 population in Europe. Optimal utilisation of these beds is essential in order to maximise the benefit to patients

Patients are commonly transferred to critical care in another hospital for care which cannot be provided in the referring hospital - because of shortage/unavailability of critical care beds or because there is specialist expertise in the receiving hospital. These transfers can be delayed because the referring hospital has to get a medical or surgical team in the receiving hospital to accept the patient under their care, even where the care will primarily be provided by the critical care team. This can lead to delays in the provision of appropriate care for the patient in critical care, especially at night or weekends.

Similarly, when patients are repatriated back to the critical care unit in the hospital which had referred them there can be considerable delays while a medical or surgical team is found to accept them under their care. This leads to delay in vacating a bed in the tertiary center (sometimes of days), time wasted for the critical care retrieval service (MICAS) and considerable time wasted by medical staff trying to make these administrative arrangements.

Exclusion: If a patient is being transferred primarily for management by a medical or surgical specialty rather than for management by the critical care team, the relevant team must accept the patient in advance of the transfer. Examples include referral for ruptured aortic aneurysm or for neurosurgical care.

Standard operating procedure for inter-hospital transfers/ repatriations primarily for ICU care

Where the primary reason for transfer is the receipt of critical care for organ support (e.g. due to shortage of critical care beds, or for more complex critical care or for repatriation) the patient can be accepted by the critical care consultant and the transfer effected.  The patients’ care must be

1. accepted by the critical care consultant and
2. a suitable critical care bed must be available, as identified in discussion with the critical care shift lead and bed management.

The patient is then admitted under the medical or surgical team on-call for emergency admissions, without having to wait for formal acceptance by these teams. These on-call team should be informed at the earliest appropriate opportunity. The on-call team can subsequently transfer the patient care to another team, if appropriate (e.g. for a repatriation, to the team who had originally transferred the patient out or specialty appropriate), during office hours.