Interhospital transfer of critically ill patients

Abstract

Transportation of a patient between medical facilities without interruption of the medical treatment can be a challenging task. This review aims to define the term "interhospital transport" and give a general overview of the steps for organizing a transfer. Furthermore we discuss the team qualification, equipment standards and how to manage adverse events before and during transport by means of patient triage. The advanced interhospital transport of the critically ill patient can be defined as follows: "transportation of a patient between medical facilities without interruption of the medical treatment and monitoring due to the underlying disease by means of specific medical, technical equipment and knowledge with the objective of improved patient care." Several organizational steps come along with patients transfer: the hospital of origin has to identify transfer-eligible patients and be willing to release the patient. It has to identify a destination hospital and negotiate the transfer; the patient has to be transportable, the patient/relatives must agree; the transporting unit has to have the infrastructure and acknowledge to transport the patient; the insurance company or the family has to guarantee for the additional costs. Relocation team members need a specific training that focus on typical critical events that happen during transport. Technical equipment (ventilator, stretcher, monitor, defibrillator, external pacemaker, blood-gas analyzer) facilitates smooth patient transition from one facility to a distant one. The use of checklists is associated with a reduction of incidents during the transport.