Transfer of adults between intensive care units in the United Kingdom: postal survey

Introduction

In 1986, at least 10 000 seriously ill patients in the United Kingdom required secondary transfer to adult intensive care units in other hospitals.1 Although 75 of 181 (41%) intensive care consultants were dissatisfied with transfer arrangements, only 10% (number not provided) ever refused a request for transfer. The establishment of dedicated regional transport services was recommended. It has also been recommended that patients should be retrieved by teams from receiving intensive care units, and that local capabilities be maintained for urgent transfer of patients with head injuries.2 3 We reviewed current secondary transfer facilities and numbers and established the main indications for transfers.

Methods and results

Late in 1994 we surveyed 278 general or mixed intensive care units in the United Kingdom by postal questionnaire; 198 (71%) responded. The mean annual admission rate to intensive care units was 353 (range 40-1540) patients, and annually an average of 23 patients were transported to each unit. The most frequently quoted reasons (not mutually exclusive) for such transfers were lack of intensive care beds (125; 63%) and of renal support services (45; 23%) in referring hospitals. Only 25 intensive care units admitted more than 40 transferred patients a year.

On average, 19 patients were transported from each unit each year. The most common indications for these transfers were referral for neurosurgical care (109; 55%), lack of beds in the intensive care unit (87; 44%), and lack of renal support services (54; 27%). Only 12 intensive care units transferred more than 40 patients a year to another hospital.

Staff and equipment for transfers were available in 191 (97%) hospitals. The 24 (12%) intensive care units which provided retrieval teams received on average 55 transferred patients a year. Only two hospitals provided “regional” transport teams. Table 1) shows equipment and staff resources. Eighty two (41%) respondents considered that arrangements for transfer were unsatisfactory. Despite this, only 19 (10%) stated that lack of facilities ever prevented patient transfer.

Comment

On the basis of data from our survey and an audit of admissions to a regional neurosurgical unit4 we estimate that the number of critically ill patients requiring secondary transport to adult intensive care units in Britain in 1994 exceeded 11 000. This estimate correlates well with that of the 1986 survey. Targeted provision of staffed beds and renal support services in existing general intensive care units would reduce the number of transfers. Conversely, regionalisation of specialist intensive care services may increase transfers unless there are fewer hospitals with small intensive care units and accident and emergency departments.

Most patients were transferred by staff from referring hospitals. Most medical escorts were unsupervised junior trainees in anaesthetics, each likely to experience few transfers. Transportation by doctors lacking suitable experience may result in a higher incidence of life threatening complications,5 especially as recommended monitoring is not universally available.2 Critically ill adults can be transferred safely by fully equipped, specialised transfer teams; although these are common in Australia, North America, and some European countries, they remain the exception in the United Kingdom.

The persistent professional dissatisfaction with transfer arrangements probably reflects having to send inadequately trained medical escorts and the need for consultants to cover the emergency service in their absence. Targeted allocation of resources is required to reduce the number of transfers and provide a national system for safe secondary transportation of critically ill adults. A system of dedicated regional transport services would result in most patients being transferred by well equipped, experienced medical attendants and would spare staff on call at referring and receiving hospitals.