Transferring the Critically Ill Patient
Inter-hospital transports can result in adverse patient events, so it’s up to the transferring physician to ensure safe passage for the patient.
Here are some important considerations when transferring a critically ill patient:
Give a good handoff: Have a clear discussion with the receiving physician (or physicians if more than one if additional specialty is required). This ensures continuity of care and ideally should confirm the receiving hospital has the services required to care for the patient.
Predict Problems: Anticipate possible emergencies and, if able, proactively intervene to prevent decompensation (e.g., intubation, central venous access, volume resuscitation, etc.)
Stabilize: Fix as many physiologic derangements as possible (e.g., hypoxia, hypercarbia, academia, etc.) to ensure the process of transfer is not further complicated by ongoing decline. Some of these issues may be why you’re transferring in the first place - but it is up to the sending physician to make the transfer as safe as possible for the patient.
Have a plan for pain: Transfers can be uncomfortable for the patient - ensure you’ve discussed pain management with the transporting team.
Be accessible: Consider providing your phone number to the transport team so they can call for continued consultation during transport.
Send records: Important records help to pick up care where it was left off at the transporting hospital (e.g., progress notes, discharge summaries, medication records, radiographs, healthcare proxy information, family contact information, etc.)
Marquet K, Claes N, De Troy E, et al. One Fourth of Unplanned Transfers to a Higher Level of Care Are Associated With a Highly Preventable Adverse Event. Crit Care Med. 2015;43(5):1053-1061.
Malpass, H. C., Enfield, K. B., Keim-Malpass, J., & Verghese, G. M. The Interhospital Medical Intensive Care Unit Transfer Instrument Facilitates Early Implementation of Critical Therapies and Is Associated With Fewer Emergent Procedures Upon Arrival. Journal of Intensive Care Medicine, 30(6), 351–357.