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An urgent or emergency inter-hospital patient transfer occurs when the diagnostic or therapeutic needs of a patient are beyond the capacity of the initial hospital. The patient will require continued assessment and possibly treatment.

Non-emergency and/or general transfers that require an ambulance or Patient Transfer vehicle may be required for non-ambulatory patients or those that require continued assessment or care.

Prior to the transfer, crews should seek to understand the requirements of the case, e.g. what specific equipment is required to perform this transfer, are there Infection Prevention & Control requirements and/or concerns (e.g. communicable diseases), is there a specific crew configuration and/or medical escort requirements.

During the transfer, staff are required to reassess the patient appropriately, clearly document any changes in the patient’s condition or any interventions that have been undertaken (whether these are administered from St John or other medical staff).

A minimum of two sets of observations should be documented in this section. 

  • As a minimum requirement, Glasgow Coma Scale (GCS), Respiration Rate (RR), Pulse (HR) Blood Pressure (BP), Oxygen Saturation (SpO2) and pain scores. It should also include, where appropriate, any of the other parameters including pupils, ECG, end tidal Carbon Dioxide (etCO2), Blood Glucose Levels (BGL), temperature, dyspnoea and weight.
  • Patient observations should be performed and documented every 20 minutes, and more frequently if clinically indicated. If this is not possible or is deemed clinically unnecessary the rationale should be documented.
  • For PTS undertaking dual transfers, observations are taken at the point of pick up, and the second upon reaching the destination. Should there be any clinical deterioration of the patient, more frequent observations are also required, in addition to calling for Paramedic backup. 
    Staff are required to share patient care and responsibility; the most senior level of trained person does remain ultimately responsible however for care delivery, even if care is delegated.

    Emergency

    Inter-hospital patient transfers on an emergency basis occur when diagnostic or therapeutic needs of a patient are beyond the capacity of the initial hospital and are required on an emergent basis.

    General

    Non-emergency and/or general transfers that require an ambulance or Patient Transfer vehicle may be required for non-ambulatory patients or those that require continued assessment or care. Given the constraints present in the setting of a dual-stretcher vehicle, compliance with regards to the frequency of recorded of observations is limited to where safe and practicable.


    Clinical Handover is essential in any transfer in order to provide continuity in patient care and should be conducted in accordance with the Clinical Handover Procedure.

    In the context of interfactility transfers, the handover must follow the ISOBAR principles and be inclusive of (but not limited to):

    • An adequate summary of the patient’s condition and level of acuity
    • Current treatment
    • Possible complications that could affect patient care in transit
    • The transfer plan, as agreed by the treating team

    This information should be conveyed verbally at the bedside and in a face to face fashion from the Doctor / Nurse in charge of the patient’s care and documented on the Interhospital Patient Transfer form (in ePCR or downloaded copy). Transfer paperwork (summary, lab work, x-rays, etc.) should be given to St John personnel prior to commencement of the transfer. The patient, family and or friends should be consulted regarding the transfer where appropriate.

    If a nursing or medical escort is accompanying the patient, crew roles and responsibilities for the patient transfer should be discussed and be clear prior to commencement of the transfer.

    In cases of an unexpected medical incident, unfamiliarity with vehicle layout and pre-hospital equipment by escorting medical teams poses a risk to patient safety and may hinder good patient outcomes. Where practicable, and to mitigate this risk, the attendant should be in the rear of the vehicle during the transfer. This may not be possible in specific circumstances, and should be included in the discussion regarding roles and responsibilities. The agreed plan should be documented.

    It is essential that St John WA staff know the accepting doctor (or team) and the desired transport destination prior to departure.

    The receiving physician should be contacted by the transferring physician, prior to transfer, with any updates and an expected estimated time of arrival.


    The level of trained staff used to transfer a patient should be appropriate to the treatment necessary or anticipated during transfer. It may be appropriate for the hospital to send specifically trained personnel to accompany the patient. Crew mix requirements and role designations should be dictated by and commensurate with clinical transfer plan, patient acuity and the clinical needs of the patient. It is a requirement of St John WA that the most senior medical escort travel with patients in the patient compartment.

    Team Roles

    • St John WA
      • Carrying out patient care and monitoring
      • Documenting observations
      • Operating the vehicle & SJWA equipment
    • Nurse
      • Managing Intravenous infusions
      • Assisting with patient care and monitoring
    • Doctor
      • Overseeing patient care

    The Doctor is the team leader and final decision maker. All opinions and concerns by all team members need to be freely expressed at all times.

    Graded Assertiveness

    Bring to attention
    e.g. "The oxygen saturations are decreasing "

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    Enquire
    e.g. "You're not going to cannulate that fractured arm, are you?"

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    Clarify
    e.g. "I feel uncomfortable about this; please explain what you are doing."

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    In critical or dangerous situations, demand a response or take control
    e.g. "LISTEN!" or "Stop – you must listen to me."


    Staff must be comfortable that they have sufficient information to accept responsibility of a patient with ongoing medication administration. Instructions for oral, IM or IV maintenance should be provided for the St John WA staff.

    Written instructions MUST be given on the Special Medication Authority section of the checklist for any medication not covered in St John WA Medication Protocols. Direction should also be sought from the transferring hospital or CSPSOC with regards to the disposal requirements of medications not covered by SJWA Medication Protocols.

    Electronic infusion devices may be managed by St John WA staff without the need for an escort, however the following information is required:

    • A direct contact number for attending doctor if more information becomes necessary
    • A tutorial is given on how to adjust rates, turn the alarm off or stop the infusion as required
    • Familiarity with Clinical Skill – IV Pumps

    If presented with an IV infusion, the key questions to address are:

    • What medication?
    • What would be the effect if the flow rate was adjusted?
    • What would be the effect if during the journey it stopped?
      • If the effects of stopping the infusion or altering the infusion rate are life-threatening or severe, a suitable escort is required.

    Escort Requirement flowchart




    References
    References

    Document Control


    Directorate
    Clinical Services

    Responsible Manager
    Head of Clinical Services

    Date

    Review Date

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