Transferring critically ill patients in North West London. Transfer data analysis

Transcription

1 Transferring critically ill patients in North West London Transfer data analysis Picture: A typical intensive care (Level 3) patient with a selection of equipment and monitors that would need to be managed / transferred with the patient Introduction: 1. This report provides key information from clinically audited transfer data reported to the North West London Critical Care Network (NWLCCN) from all acute hospitals within North West London. 2. The report describes the transfer pathways experienced by critically ill patients in North west London; risk exposure for patients being transferred; risk reduction/ prevention; resource management; training needs for staff escorting critically ill patients and whether these are met through current activities. 3. The report has been produced for: Patients and their relatives Hospital staff o Doctors and nurses responsible for critical care and transfers o Trainee doctors o Hospital lead Executives for critical care services o Hospital general and service managers Clinical commissioning groups and others who fund critical care Page 1 of 6

2 4. The hospitals included in this report are Chelsea and Westminster Hospital NHS Foundation Trust Ealing Hospital NHS Trust Hillingdon Hospitals NHS Foundation Trust Imperial College Healthcare NHS Trust (Charing Cross, Hammersmith and St Mary s Hospitals) North West London Hospitals NHS Trust (Central Middlesex and Northwick Park Hospitals) Royal Brompton and Harefield Hospitals NHS Foundation Trust The Royal Marsden NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust West Middlesex Hospital NHS Trust Why do we move critically ill or injured patients from one hospital to another? 5. It is vital that critically ill or injured patients are treated rapidly in an acute hospital in order to stabilise them or limit their injuries. However, there are several instances when such management may be followed by further (secondary) transfer to another acute hospital: o Clinical transfer when the facilities needed for definitive treatment are not available at the initial hospital. o Capacity transfer when the initial hospital has inadequate equipment, bed capacity, staffing or monitoring to provide the necessary care. o Repatriation highly specialised hospitals may need to transfer patients to ensure they can treat the next patient who needs their specialist facilities. Patients may also be moved back to hospitals nearer to their home and family. In these cases, patients will have had their specialist treatment, are almost always stable and the transfer may involve a step down in the level of their care. Where are critically ill or injured patients transferred from? 6. Patients may need to be transferred from a hospital s o Emergency Department (ED), o Intensive Care Unit (ICU) or High Dependency Unit (HDU), o Operating Theatre, o Radiology/endoscopy department, o Ward, o Maternity unit. Where do critically ill or injured patients get transferred to? 7. Patients will always be transferred to the nearest available, appropriate facility. This may be to another ICU or HDU, direct into theatre for surgery at another hospital, to imaging in another hospital or to a major trauma centre ED as a secondary transfer. Page 2 of 6

3 Why is it important to document and audit transfers? 8. NWL CCN has developed and implemented standard transfer documentation. This documentation is issued in books to all hospitals within the Network and is updated annually by the Network Transfer Faculty Group. 9. The Network standard documentation provides: o A legal record of the patient s intervention (the transfer) for both referring and receiving hospitals o A safety checklist from A to P for staff to use o Information on the patient s journey and outcome for audit, evaluation and service improvement How many transfers have network documentation? 10. The median (mode[range]) percentage for completing transfer documentation during , was 94(100[60 100])%. 11. A simple way of interpreting this is that about 95% of all our critically ill or injured patient transfers from any area within the hospitals in North West London are documented and audited via our dedicated transfer forms. Audit data for Level of care 12. Figure 1 shows the number of critically ill (Level 3 = intensive care; level 2 = high dependency care) patients transferred in North West London during according to the classifications in paragraph 5. There were n177 clinical transfers (n132 Level 3 and n45 Level 2). There were n83 capacity transfers (n74 Level 3 and 9 Level 2). There were n40 repatriation transfers (n28 Level3 and n12 Level 2) Page 3 of 6

4 Clinical transfers 13. Of the clinical transfers, 63 patients were transferred to neuro Intensive Care Units for specialist neurological/neurosurgical treatment. 35 patients were moved to Queen Square Hospital. 26 patients were moved to Imperial College Healthcare Trust. 14. Four (4) children were transferred to Paediatric Intensive Care Units (PICUs) by the referring hospitals adult transfer teams. 15. Thirteen (13) patients were transferred to the Royal Brompton Hospital from around the country by the Royal Brompton s specialist retrieval team in order that they receive extra corporeal membrane oxygenation (ECMO) therapy. 16. In , of the critically ill patients who required transfer, 34 patients were moved outside North West London for clinical reasons all except one of these patients stayed within London There were 21 patients moved outside of North West London for capacity reasons. Why do we worry about transferring critically ill or injured patients? 18. Critically ill patients are vulnerable to harm from transfer. They are unstable and at risk while looked after by a limited team isolated from a main hospital and with limited equipment. The patient s condition may change rapidly even if they have been stabilised before transfer. The environment, restricted space and motion of the ambulance can make it difficult to deliver high intensity care. The process of movement may itself cause deterioration. Acceleration and deceleration can affect the patient circulation. There is a risk of accidental disconnections and equipment failures and it can be hard to keep the patient warm. 19. The risk categories used by the NWL CCN to classify important adverse (critical) incidents are: a. Patient airway management issues b. Battery failure (for equipment) c. Clinical deterioration d. Equipment problems (other than battery failure) e. Inadequate preparation (for transfer) f. Organisational (including communication problems) 1 Only 1 of these patients required a clinical transfer out of London. In this instance the patient was from outside London and was moved from a specialist tertiary centre to the most local hospital that provided specialist renal services for his on-going needs. Page 4 of 6

5 20. Figure 2 shows the breakdown of reported critical incidents (from 300 level 2 and 3 transfers) during : 21. Figure 3 shows how the total number of reported incidents has varied over the past 6 years. Note that the number increases initially; this change was anticipated as incident reporting increased. Note also the reduction following following the introduction of Network wide transfer training and measures aimed at improving specific incident trends (in particular battery/equipment problems). Intervention Page 5 of 6

6 How else have we used this information to influence what we are doing? 22. The extensive audit information collected over the past 6 years (some of which is presented above) has allowed us to identify where problems arise. As a result, we have been able to develop a number of interventions to improve patient care and safety. These include: a. Transfer training dedicated training for those who need to escort critically ill patients during transfers. b. Focusing on equipment issues (as described above) c. Influencing design changes to ambulances in order to better accommodate critically ill patients d. Educating those responsible for providing or funding health care (in North West London) on transfer issues and patient safety. 23. If you would like to know more about the transfer of critically ill or injured patients in North west London, have questions about the information in this report or would like to contact the North West London Critical Care Network please get in touch on : critcarenetworknwl@nhs.net 24. Geographically, the Network covers the London Boroughs of Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea, and Westminster. North West London Critical Care Network Footnote: The North West London Critical Care Network also provides transfer documentation, audit and transfer training to Independent hospitals that have critical care services within North West London Page 6 of 6