The transfer of patients is potentially hazardous if poorly executed and new guidelines aim to reduce risks and improve outcomes.
The Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society have developed guidelines to help ensure the safe transfer between hospitals of patients with a brain injury.
The transfer of patients is potentially hazardous if poorly executed and these updated guidelines are for those responsible for planning, managing and undertaking transfer of brain injured patients. The aim is to ensure a safe transfer of patients and also to assist in local discussions when establishing new or improving existing transfer arrangements.
The location of care for many brain-injured patients has changed following the development of major trauma centres and advances in management of ischaemic stroke have led to the urgent transfer of many more patients. Patients with an isolated head injury, major trauma, and those who deteriorate while in hospital may require transfer between hospitals. In some regions, critical care networks and transfer groups have been established, but elsewhere patients with a brain injury will require staff within a local unit to arrange and undertake a transfer.
The guidelines provide 11 recommendations, covering key areas including:
Organisational aspects - The safe transfer of patients with brain injuries requires an effective partnership between the referring teams, the regional neurosciences or stroke unit, and the local ambulance service. Every hospital that receives patients with serious brain injuries should have facilities for resuscitation and diagnosis, including 24 h access to CT imaging. Appropriate staff and equipment should be available at all times to ensure a safe transfer to the neuroscience unit when necessary.
Preparation for transfer - The decision to transfer a patient with a brain injury should be made by senior medical staff at the referring hospital in consultation with senior staff at the neurosciences unit. Appropriate resuscitation and stabilisation of the patient before transfer is the key to avoiding complications during the journey. When a request is made for an ambulance to transfer the patient (including those with acute ischaemic stroke), the dispatcher should be told the patient has a life-threatening emergency.
Care during the transfer - During transfer, patient management will be centred on maintaining oxygenation and adequate blood pressure, and minimising rises in ICP. As far as possible, a smooth journey (without marked acceleration and deceleration) will have less impact on a patient with an injured brain. A patient who is physiologically stable before departure is more likely to remain so for the duration of the transfer, although there is still the need for constant vigilance and prompt action to deal with complications.
Paediatric transfers – Paediatric transfers are high-risk and there should be a pre-determined pathway for referral and transfer of brain-injured children developed in agreement by the regional transport service, regional trauma network and the regional neuroscience network.
Dr Mike Nathanson, President-Elect of the Association of Anaesthetists and Chair of the guidelines working party, said: “We believe that high-quality transfer of patients with a brain injury is associated with a better outcome. These guidelines encourage departments to review their own practices and suggest training and organisational improvements to ensure safe transfer with the aim of avoiding harm to patients. Most principles of safe transfer are common to all seriously ill patients, but these guidelines highlight specific risks that apply to those with an acute brain injury.”
Roger Lightfoot, President of the Neuro Anaesthesia and Critical Care Society, said: “The collaboration of the Neuro Anaesthesia and Critical Care Society with the Association of Anaesthetists has allowed this version of the guidelines to be relevant and set the correct standards to ever developing area of patients with acute brain injury. The important inclusion of organisational aspects as well as clinical guidelines will allow local departments to undertake a comprehensive review of their own practice and therefore improve care.”
The guidelines are published in the journal Anaesthesia and can be accessed at: https://doi.org/10.1111/anae.14866
