Scottish audit of interhospital transfers of acutely ill adults

Introduction

The audit was commissioned by the Scottish Government Health Department to identify the number of acutely ill adults transported between hospitals by the Scottish Ambulance Service (SAS). Currently interhospital transfer (IHT) of acutely ill adults requiring medical escorts is undertaken by the SAS Accident and Emergency (A&E) ambulances or by dedicated transport teams (for example, Glasgow Shock Team and Emergency Medical Retrieval Service).

Methods

The audit ran for 20 weeks. Patients over 16 years old who required intervention/vital signs monitoring during transfer or who required a nursing or medical escort were defined as acutely ill. Audit forms were placed in every A&E ambulance.

Results

A total of 3,068 forms were received, with 2,396 audited. Twenty per cent were emergencies, 73% urgent and 7% planned. The median SAS journey times, patient and dedicated team journey times are presented in Table 1. The majority of IHTs occurred for specialist management (65.9%) or specialist investigation (23%). A total of 820 IHTs were clinically escorted, including the Glasgow Shock Team (n = 192) and the Emergency Medical Retrieval Service (n = 13). Two hundred and forty-eight patients were ventilated (10.3%). Eighty-four (3.5%) IHTs required clinical intervention to correct clinical deterioration. An adverse event occurred in 1.5% (22). One hundred and thirteen (18%) escorted IHTs by nondedicated transport teams had unsecured medical equipment versus 2/205 (0.97%) in dedicated transport teams (P = 0.004). Equipment failures occurred in 9/97(9.2%) ventilated transfers by nondedicated teams versus 1/156 (0.6%) by dedicated teams (P = 0.001). The SAS executive information service data showed a total number of IHTs during the audit period conveyed by A&E ambulances as 19,747 (18,343 adults). This approximates to a total of 51,342 per annum (47,692 adults) or 917 adults per week.

Table 1 Journey times (hh:mm)

Conclusion

The most frequent reason for IHT is specialist management or investigation. Adverse events are reassuringly uncommon. Unsecured medical equipment and equipment failure during an IHT is significantly more frequent when undertaken by nondedicated transport teams.