Abstract
Aims: To describe the nature, frequency, and characteristics of adult critical care transfers originating from the emergency department (ED).
Methods: A one year prospective regional descriptive study using multiple data sources of all critically ill adults transferred from an ED or a minor injuries unit (MIU) within the former Yorkshire Regional Health Authority Area or into a regional critical care facility if originating from an ED or MIU elsewhere.
Results: 29 EDs transferred 349 adults into the regional critical care facilities. The median number of transfers per department within the region was 18 (range 1 to 42). Seventeen were transferred from outside the region. A total of 263 (75%) patients were transferred for specialist care and 76 (22%) for non-clinical reasons. Altogether 294 (84%) were admitted to intensive care or a high dependency unit at the receiving hospital. The in-hospital documented mortality rate was 26%. A total of 170 patients (49%) had traumatic pathology of which 101 were principally transferred for management of a head injury. Median time in the ED was 3 hours 5 minutes (range 11 minutes to 17 hours 47 minutes). In 146 (42%) patients the decision to transfer was primarily made by the emergency medicine clinician. A total of 251 (72%) patients were intubated. The documented critical incident rate was 15%.
Conclusion: Trauma is the most common reason for transfer of the critically ill adult from the ED. A significant number of patients are transferred, however, with medical and surgical conditions and for non-clinical reasons. There continues to be problems with the quality of care that these patients receive. Emergency medicine clinicians must be actively involved in the development of regional critical care systems as a significant proportion of all critically ill adults transferred originate from the ED.
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Selected References
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- Bion J. F., Wilson I. H., Taylor P. A. Transporting critically ill patients by ambulance: audit by sickness scoring. Br Med J (Clin Res Ed) 1988 Jan 16;296(6616):170–170. doi: 10.1136/bmj.296.6616.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Braman S. S., Dunn S. M., Amico C. A., Millman R. P. Complications of intrahospital transport in critically ill patients. Ann Intern Med. 1987 Oct;107(4):469–473. doi: 10.7326/0003-4819-107-4-469. [DOI] [PubMed] [Google Scholar]
- Gentleman D., Jennett B. Audit of transfer of unconscious head-injured patients to a neurosurgical unit. Lancet. 1990 Feb 10;335(8685):330–334. doi: 10.1016/0140-6736(90)90615-c. [DOI] [PubMed] [Google Scholar]
- Hicks I. R., Hedley R. M., Razis P. Audit of transfer of head-injured patients to a stand-alone neurosurgical unit. Injury. 1994 Oct;25(8):545–549. doi: 10.1016/0020-1383(94)90098-1. [DOI] [PubMed] [Google Scholar]
- Lambert S. M., Willett K. Transfer of multiply-injured patients for neurosurgical opinion: a study of the adequacy of assessment and resuscitation. Injury. 1993 May;24(5):333–336. doi: 10.1016/0020-1383(93)90058-e. [DOI] [PubMed] [Google Scholar]
- Mackenzie P. A., Smith E. A., Wallace P. G. Transfer of adults between intensive care units in the United Kingdom: postal survey. BMJ. 1997 May 17;314(7092):1455–1456. doi: 10.1136/bmj.314.7092.1455. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Connor P. M., Steele J. A., Dearden C. H., Rocke L. G., Fisher R. B. The accident and emergency department as a single portal of entry for the reassessment of all trauma patients transferred to specialist units. J Accid Emerg Med. 1996 Jan;13(1):9–10. doi: 10.1136/emj.13.1.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Olson C. M., Jastremski M. S., Vilogi J. P., Madden C. M., Beney K. M. Stabilization of patients prior to interhospital transfer. Am J Emerg Med. 1987 Jan;5(1):33–39. doi: 10.1016/0735-6757(87)90285-3. [DOI] [PubMed] [Google Scholar]
- Runcie C. J., Reeve W. R., Wallace P. G. Preparation of the critically ill for interhospital transfer. Anaesthesia. 1992 Apr;47(4):327–331. doi: 10.1111/j.1365-2044.1992.tb02175.x. [DOI] [PubMed] [Google Scholar]
- Smith I., Fleming S., Cernaianu A. Mishaps during transport from the intensive care unit. Crit Care Med. 1990 Mar;18(3):278–281. doi: 10.1097/00003246-199003000-00006. [DOI] [PubMed] [Google Scholar]
- Vyvyan H. A., Kee S., Bristow A. A survey of secondary transfers of head injured patients in the south of England. Anaesthesia. 1991 Sep;46(9):728–731. doi: 10.1111/j.1365-2044.1991.tb09766.x. [DOI] [PubMed] [Google Scholar]