Why Transfer Medicine Matters

In this article, we hear from the North Central London Adult Critical Care Transfer Service (NCL-ACTS) about their experience of developing a transfer service and why transfer medicine matters.

The NCL-ACTS Story

In early 2020, we watched our intensive care units start to fill with patients suffering with a novel disease – COVID-19. By April of that year, COVID-19 was firmly part of global vocabulary and had taken over every aspect of our working and personal lives. As patients filled the intensive care units, reports were coming in across our London network of smaller units not only exceeding capacity but at risk of collapse under the strain of critical patients. Rapidly, the critical care network agreed upon a plan to decompress and distribute the burden of patients across the wider NHS trusts.

On a Monday, the development of a dedicated North Central London Adult Critical Care Transfer Service was proposed and by Thursday we were in the back of an ambulance with whatever available equipment we could find to retrieve our first patient. We drew on the experience of existing transfer teams, like those for paediatric critical care transfer and retrieval, other regional adult critical transfer specialists and pre-hospital retrieval teams from the worlds of critical care, anaesthesia and aeromedical retrieval to build our service.

As with any service, the early days were filled with lots of learning. For example, when one of the first transfers was being handed over to the accepting unit – a bariatric patient with severe COVID-19 pneumonitis – the patient suffered a rapid desaturation and actually had a cardiac arrest when the transfer ventilator’s oxygen supply was swapped from a cylinder to piped wall oxygen. When we debriefed the incident, it came to light that many people didn’t know that that model of ventilator didn’t maintain positive end expiratory pressure (PEEP) when changing oxygen supply. We were able to use that learning and prevent future adverse events.

Through the pandemic waves and now years of operation, NCL-ACTS has now grown into a well-established, efficient and integral team for our sector. We have used multidisciplinary consensus and learning from experts to transfer some incredibly challenging patients. For example, when the critical care networks were faced with limited level 2 capacity and ability to provide non-invasive ventilation in the second wave, NCL-ACTS used tiered support and multidisciplinary educational tools (including in-situ simulation) to allow the development of a standard operating procedure to transfer COVID-19 patients safely with ongoing non-invasive ventilation.

So why does transfer medicine matter to us?

For us, having a well-working dedicated multidisciplinary team with good knowledge of the principles of safe transfer medicine practice means that we can run efficiently, meet the needs of our population and most importantly be safe for our patients and staff.

Think about your reasons for working in transfer medicine and why transfer medicine matters to you and start a discussion below

Laura is a transfer practitioner working with the East of England Adult Critical Care Service. Here she gives a great reason to bear in mind as we take on transfer challenges.