Feb. 07, 2020
Transfer of the critically injured patient is essential to ensure expedient care with appropriate resources. However, determining the need for and facilitating the best possible transfer process for the patient, staff and facilities involved goes beyond just following a simple algorithm: It's an art.
Two staff members at Mayo Clinic's campus in Rochester, Minnesota, who are intimately involved in the patient transfer processes — Erica A. Loomis, M.D., a trauma surgeon, and Chad P. Liedl, M.S., R.N., a nurse manager for the Midwest Admission and Transfer Center (MATC) — offer some tips on best transfer practices.
Ensure patient stability
Make sure to address life-threatening issues such as uncontrolled bleeding or an airway problem prior to patient transfer. If you don't provide initial lifesaving maneuvers, the patient is unlikely to make it to the receiving hospital. At the same time, delaying transfer for unnecessary tests should be avoided; for example, obtaining a CT scan while the transport helicopter is waiting is not in the patient's best interest.
Contact the MATC promptly in the patient's assessment. Any team member from your facility may call the MATC. Mayo staff will arrange the appropriate next step for the patient, such as a telemedicine consult, air transport or ground ambulance. The transfer and transportation can be cancelled at any time prior to the patient's departure. It's simply good to initiate the transfer request early to get the needed help and expertise.
Make certain a transfer is required
When considering a transfer, assess whether the patient ultimately can be helped or if further intervention may be medically futile. Also, determine whether the resources at your facility might make keeping the patient closer to home possible. Though conferring with a physician or surgeon at a potential receiving hospital takes more time, it can be prudent if the need for additional services remains unclear.
Provide organized information
Be prepared to supply the following:
- Patient demographics
- Referring provider name and a callback phone number
- Vitals (highest heart rate, lowest systolic blood pressure and most recent set of vitals), injuries identified, time and mechanism of injury, treatments initiated, and Glasgow Coma Score
- Images, if available ― the MATC can advise on how to transmit images, if the process is unfamiliar.
- Pertinent past medical/surgical history, allergies and home medications
Dr. Loomis says presenting information in an organized manner is essential so that receiving providers can easily grasp pertinent information. When a patient is triaged incorrectly, she says, it's often due to information coming in sideways.
Liedl adds that information directly pertaining to the injury — rather than an underlying cause — should be highlighted, as the injury often causes the most immediate trouble and is therefore crucial for the patient's outcome. Providers often will address underlying conditions simultaneously during treatment at the receiving center.
Choose the appropriate mode of transfer
Ultimately, the decision about — and responsibility for — mode of patient transfer resides with the sending facility. If needed, a transfer quality review will provide feedback related to transport selected as a tool for all involved in the care to learn and improve for the next case.
When selecting a mode of transport, the risks and benefits must be weighed. Dr. Loomis says selecting an inappropriate means of transfer can be a resource burden: If you are moving one patient with a particular transport, it cannot move another patient who might need it more acutely. She also explains that an inappropriate mode of transport, such as a helicopter launch if not imperative, may incur unnecessary risk for staff.
Try to avoid a double transfer
Double transfer may put a patient needing immediate care at risk, due to lost time. If questions arise about an appropriate receiving hospital, connect with the MATC for consult.
Trust the process
Though it might seem more efficient to attempt to arrange a direct patient admission rather than another emergency department visit, following the process as established, including a full trauma work-up at the receiving hospital, is safest and likely will result in the best outcome for the patient, says Liedl.