Service Preparation
Critical care transfers may be carried out by dedicated transfer services or on an ad-hoc basis by any available team.
In 2021, NHS England produced a service specification for Adult Critical Care Transfer Services. (Note there are several lengthy documents in this link, the first is the most useful if you’d like to better understand the NHS ACCTS service specifications.)
However, bespoke and dedicated critical care transfer services have existed for decades in many other countries. In this article, we learn about service preparation from the Children’s Acute Transport Service (CATS) in London.
- CATS was started in 2001 as a collaboration between the paediatric intensive care units in North London and is a stand-alone service. It is one of the largest specialist paediatric transport services in Europe, serves around 50 hospitals and moves around 1200 critically ill children a year by road and air.
- As well as transferring critically ill children, CATS provides expert advice and educational support to the region. Here, CATS share their expert opinions and experience on how to minimise risk, as well as some of the factors which contribute to service preparation in paediatric and neonatal transfer teams internationally.
Communication & Referral Pathways
- How do referring centres contact a transfer team? Transfer does not happen in a vacuum – transport teams must be readily accessible. The majority utilise a central telephone hotline, and in order to function well, the hotline needs to have the ability to accept multiple callers at once, support conference calls, and be staffed at the times that the service is operational.
- Referral criteria for your service should be agreed at a regional level based on population need.
- Regular contact between the transfer service and the clinical teams enables anticipation of potential transfers – for example, attendance at a sector-wide critical care bed capacity meeting.
Recording
- For medicolegal purposes, many transfer teams record all referral calls. This can be useful to review what has been said, both for training purposes and learning from poor outcomes and if there is a disagreement amongst teams. If your team is using a recorded line, it is mandatory to let all callers know that the call will be recorded.
Back-Up
- There should be a back-up system in place for situations where the local power, telephone service, or internet goes down so that clinical teams can refer through a different route. This system should be tested regularly.
Call Answering
- Different teams use different staff to answer calls. Non-medical administrative team members can be very helpful in taking initial demographic details and triaging callers to the correct medical team member.
- Some teams have clinical members (e.g. doctors, nurses, EMS) available to answer calls directly while some use these team members as a second-line after administrative screening.
Uniforms
- Transfer teams work in a variety of environments, in all seasons, and in the case of CATS, all hours of the day and night! As such, it is crucial to choose a uniform that suits the needs of your team.
Uniforms identify transfer team members and make communication easier in busy hospital environments to minimise risk.
Weather – Choose a uniform that protects staff from harm posed by the local weather
Comfort and flexibility – Team members often work 12-hour shifts and need to be able to manoeuvre in the cramped spaces of ambulances, helicopters, and elevators. As such, it is important to choose a uniform which is comfortable and not restrictive to movement.
Visibility – Transfer teams often work at night and may find themselves on the side of the road. High-visibility reflective uniforms are a key component for staff safety.
Service Preparation On The Day
- In order to run an efficient team, it is also important to establish routines for daily operations (such as handover from shift-to-shift), ensure appropriate equipment is available and that any safety issues are communicated. We will explore these elements in more detail in Week 2.
Handover
- Clinical handover of ongoing transfer or advice cases is essential to service operation. Handover is a crucial time and communication should be clear and organised.
Vehicle & Equipment Check
Environment
- Awareness of weather and traffic conditions allows anticipation of potential delays and adjustment of routes.
Safety
- Ensure that local and national safety alerts are communicated to the team. This may include anything from drug shortages or equipment manufacturing issues to local office issues like leaky faucets or low stock.
- Having a built-in daily review of active safety issues helps to ensure shared situational awareness.
We will return to CATS and explore the world of paediatric retrieval and transfer in Week 4.
