Taking A Referral

When transferring patients between critical care units, the decision to transfer is the joint responsibility of the referring and receiving consultants at each unit. Once this decision has been agreed, the case may be referred to a transfer service to carry out the transfer.

• The initial call is the start of the journey and should not be rushed. Take your time and use a structured approach.
• You can see how Caroline takes control of the call and uses a checklist to ask all important questions. This way, she will always remember to ask for details, such as the Body Mass Index (BMI), the infectious state and any tubes and lines. Importantly, she clarifies whether the next of kin has been informed about the transfer.
• She receives a top-to-toe assessment of the patient, which ensures the referring team provide a comprehensive picture of the patient.
• This discussion can also be used to prepare the patient for transfer in advance. For example, Caroline asks for the nasogastric feeding to be stopped and the tube aspirated. If you think a patient will need an invasive blood pressure monitoring for transfer, you might ask the referring hospital to insert an arterial line while you are on your way to them. This saves time and increases the efficiency of the service.

Take time for a concise team brief before you leave for a job. This ensures everyone in the team is on the same page. It may be useful to clarify roles again at this point as they may need to be adapted for different patients.

• It is helpful to discuss the case with the team before leaving. See in this video how different team members add perspective and crucial input into planning the transfer.
• We’ve seen in Week 1 that logistical aspects, such as route planning, are as important as medical issues like the amount of vasopressor support the patient is needing. Calculation of the oxygen demand is equally important and we’ll look at this in more detail shortly.

Think about the similarities we’ve seen here with the pilots’ brief in Week 1. Do you think anything important was missed during the referral or brief? Would you do things differently in your service?

Please note: this video is a simulation and does not depict a real-life clinical event. The clinical details used in the simulation are invented and do not describe real patients. Everyone featured has kindly given their permission for the video to be used.