Transferring the critically unwell patient

Transferring patients can be defined as any movement outside of the bedspace. These movements can happen for a multitude of reasons, including bed capacity, infection control pressures, acuity and the need for diagnostic imaging etc.
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Transferring the critically unwell patient

Transferring patients can be defined as any movement outside of the bedspace. These movements can happen for a multitude of reasons, including bed capacity, infection control pressures, acuity and the need for diagnostic imaging etc.
Inspire identity for the blog transferring the critically unwell patient

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Inspire identity for the blog transferring the critically unwell patient

Transferring patients can be defined as any movement outside of the bedspace. These movements can happen for a multitude of reasons, including bed capacity, infection control pressures, acuity and the need for diagnostic imaging etc. There are two types of transfers carried out for patients within critical care. These include inter-hospital (external) and intra-hospital (internal). Despite common misconceptions, both have risks associated and should be carried out by registered professionals.

Within the UK there are on average 95,000 transfers per year, with 25% of these being critical care transfers (ICS 2019).  However, whatever the transfer, whether it be inter or intrahospital there should always be:

When our patients become seriously unwell, it increases our anxiety, our stress levels increase, and it is easy to become cognitively overwhelmed. Having so much to process and deal with can become a burden to us. When a person becomes so sick that they need to be transferred, either to CT, X-ray or ICU, this stress is increased. This article will not only look at why we are more stressed during this time but how it is we can overcome this.

Stress occurs in our everyday lives, in our work, our relationships finances, it’s everywhere! But is it a good thing?

Stress motivates us to get up in the morning and go to work, drives us to complete our jobs, and pushes us to perform to high standards. So, stress is often regarded as a motivator. However, we also consider stress to be a negative thing. When we are stressed, we can forget things, make mistakes, and fail to achieve our common goals. A good visual demonstration of this can be seen in the diagram below. (Yerkes, R. M., & Dodson, J. D. 1908)

Graph showing the zone of delusion and the ideal zone

Let’s now apply stress within critical care and the caring environment.

Let's consider the following scenario

How do you feel when you read this next statement?

“It’s 03:30, in the morning, you have just come back from your break, you are sleepy and hungry, and you have just received a handover for your patient whilst you were on break. Your patient has developed sepsis and has increased oxygenation requirements and needs to go to ITU via CT immediately, you have been asked to transfer them as there is no other support in the hospital”.

How does that make you feel? Stressed, confused, asking more questions, panicked or even just scared?

So how can we help minimise the stress? Perhaps even harness it?

Within Critical Care we utilise the A-E assessment (Airway, Breathing, circulation, Disability, Exposure) criteria.

However, within transfers we have adapted this to go further, to consider the patients and organisational factors including the team around us.

A-I assessment tool

Assessment of the patient  
A-Airway
B-Breathing
C-Circulation
D-Disability
E-Exposure and fractures
F-Fluids and electrolytes
G-Gut
H-Haematology
I-Infection
Organisational  
J- Just in case (mobile, money)
K-Kit check
L-Lab results
M-monitoring (does it work? How’s the battery? Do you need spares?)
N-Notes and x-rays
O-Organisational
P-Paperwork
Q-Quality control
R-Risk Assessment
I-Infection

Airway

Whilst considering our normal patients airway assessment consider some other things too

Breathing

Circulation

Disability

Exposure

Fluid and electrolytes

Gut

Haematology

Infection

Stress and decision making

Now let’s consider the nurse on the ward once more, what techniques are available to help them eliminate stress?

Good decision-making is one of the key things in managing complex situations, however, how best is this achieved? One tool commonly used amongst medics is the Eisenhower decision-making tool (Walsh, R. 2008). This tool enables clinicians to focus on essential actions and reduce cognitive overload.

Graph depicting the levels of importance and unimportance to task management

By using this tool, we can organize our thoughts, and use it within risk assessing our patients, reducing stress and anxiety for us and our patients.

By understanding the structured approach to patient assessment and leveraging decision-making tools, healthcare professionals can better navigate the challenges of transferring critically unwell patients. This preparation and guidance not only minimises risk but also helps harness stress as a tool for enhanced situational awareness, leading to better outcomes for both patients and care teams.

ICS (2019). Transfer of the critically ill adult. [online] ics.ac.uk. Available at: https://ics.ac.uk/resource/transfer-critically-adult.html.

Page, D.R., Dr. Ellen O’Sullivan, Tierney, D.E., Pickering, D.B., Bergin, D.A., Kennedy, D.J., Loughrey, D.J. and Power, D.M. (2006). Inter-hospital transfer of the critically-ill patient in the Republic of Ireland. doi:https://doi.org/10.21466/g.i-htotc.2006.

Walsh, R., 2008. Time management: Proven techniques for making every minute count. Simon and Schuster.

Available at: Time Management: Proven Techniques for Making Every Minute Count – Richard Walsh – Google Books

Yerkes, R. M., & Dodson, J. D. (1908). “The relation of strength of stimulus to rapidity of habit-formation.” In Journal of Comparative Neurology and Psychology, 18(5), 459-482.

Available at: Classics in the History of Psychology — Yerkes & Dodson (1908)

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Steve Cutler

Senior Charge Nurse - Practice Development, Barts Health NHS Trust

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