Patients transferring

The basic concept of prehospital care and patient transfer is carrying the patient to a facility capable of rapid revascularization, if fibrinolysis therapy is contraindicated. If the patient cannot be transferred to the facility capable of prompt intervention, fibrinolytic therapy is strongly recommended to start within 90 minutes of first medical contact. After such treatment, medical therapy will become important in managing the patient. 

Patients transferred between departments or hospitals either not identified or double counted... 

Page, N. W. (2000). Development of an advanced life support patient transfer training program. Military Medicine, 165(11), 821-823. 

In most hypertensive emergencies (except for dissecting aneurysm) hydralazine 5-20 mg i.v. may be given over 20 min, when the maximum effect will be seen in 10-80 min it can be repeated according to need and the patient transferred to oral therapy within 1-2 days. 

Although the basic pathophysiology is similar for the various causes of hypovolemic shock, there are unique considerations relative to each. For example, whereas isolated head injuries associated with trauma typically do not result in substantial blood loss or shock, pelvic fractures may sequester several liters of blood as hematoma formation. Patients with traumatic or thermal injuries, as well as postoperative patients, may have substantial fluid accumulation in sites where it cannot be readily transferred back into blood vessels (i.e., third-spaced fluid) for maintaining pressure. With these types of injuries, prompt control of compressible bleeding sources with rapid patient transfer to the hospital for definitive treatment may preclude the cascade of events leading to shock. Indeed, with trauma patients, a scoop and run approach is used in most urban hospitals that places a priority on rapid transport to a hospital. ... 

In a recent meta-analysis of the six randomized trials, patient transfer for primary PCI was associated with a 42% reduction in the composite endpoint (death/reinfarction/stroke), compared with a strategy of on-site thrombolysis (Fig. 4.10) (95). This was driven mainly by a reduction in the incidence of reinfarction (68% reduction) and stroke (56% reduction), but there was also a trend toward improved survival with PCI. Overall, these findings strongly support community wide adoption of a transfer strategy for mechanical reperfusion, as long as patient transfer can be accomplished within time intervals similar to those described in the randomized trials. The challenge now is to overcome logistical obstacles and replicate these impressive results in clinical practice. 

Deaths per 1000 patients having developed specified complications of care dniing hospitalization. Excludes patients age 75 and older, neonates in MDC 15, patients admitted from long-term care facility and patients transferred to or from other acute care facility... 

The patient assistive devices classification includes items such as walkers, bedpans, prosthetic limbs, canes, robotics, trapeze bars, wheelchair, orthot-ics (i.e., braces and shoes), patient transfer devices, and stand assist lifts. The six items belonging to the nurse protective devices classification are gloves, face masks, patient transfer devices, hand sanitizer dispensers, mechanical lifts, and gowns. The pahent protective devices classification includes items such as listed below [4] ... 

Gaps in the continuity of care. For example, patient transfers between imits, to the operating room, or from the IGU or emergency department are vulnerable in terms of the continuity of information. Transfers of care between physicians, nurses, specialists, and consultants at changes of shifts and sign-out of coverage to parmers also introduce risk. 

Education on the back and proper body mechanics Recurring training on patient transfer techniques Exercise routines for those involved in lifting Formation and required use of lifting teams Ergonomic evaluations to detect problem areas Effective housekeeping procedures Lift and patient assist equipment... 

Ability to use patient transfer device. Maneuverability of transportation device. Transportation device deemed safe. 

Provide recurring training on patient transfer techniques... 

Wheel-locking capability and need for safety straps Side rail height sufficiency to prevent falls Need to transfer IV poles Ability to accommodate patient positioning Mattress on gurney is held in place Ability to use patient transfer device Maneuverability of transportation device Transportation device deemed safe... 

Another measure of severity of illness is the need for transfer back to acute care. Chan et al. found that 37% of patients transferred to a ventilator care unit required ICU readmission (40). In another study of 97 patients (71 still on MV) transferred from the ICU to long-term acute care, 23% were readmitted to ICU within 30 days (41). 

In a retrospective study of 319 patients, multivariate analysis identified shock on ICU admission day as the only independent predictor for PMV (>21 days) (47). In a prehminaty study of 111 patients, increased duration of MV and need for transfer to a long-term ventilator care facility was associated with a creatinine elevation of 1.3 mg/dL anytime during the ICU stay (48). In another study, none of the 52 patients with PMV and renal failure were successfully weaned (49). Chao and colleagues reviewed >1000 patients transferred to their regional weaning center and identified 63 with renal dysfunction, with creatinine >2.5 mg/dL (40 on renal replacement therapy) (50). When compared to those with creatinine <2.5 mg/dL, patients with renal dysfunction were less likely to wean from MV (13% vs. 58%). 

LTAC hospitals have higher patient-to-nurse ratios, standardized services, and standard protocols for weaning. Nevertheless, a study of 7440 patients transferred from 155 acute care hospitals to LTAC units reported that costs remain high for PMV patients (usually reimbursed under DRG 483), even in an LTAC hospital, and concluded that this subgroup of patients is still a source of uncompensated care (27). 

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