Can I transfer patient care?

Patient Transfer Guidelines

Yes, you can transfer patient care, but only after ensuring proper stabilization, establishing formal transfer agreements, securing acceptance from the receiving facility, and arranging appropriately trained personnel to accompany the patient. 1

Key Prerequisites Before Transfer

Patient Stabilization Requirements

Before any transfer can occur, the patient must be medically stabilized to the extent possible at your facility 1:

• Secure intravenous access (peripheral or central if peripheral unavailable) 1
• Airway management must be completed before transport if intervention is likely needed en route—endotracheal intubation should be performed at the referring hospital, not in a moving vehicle 1
• Fluid resuscitation and inotropic support initiated as needed, with all medications in plastic (not glass) containers 1
• Nasogastric tube placement for patients with ileus, obstruction, or requiring mechanical ventilation 1
• Foley catheter for strict fluid management and extended transports 1
• Chest decompression with tube thoracostomy before transfer if indicated 1

Mandatory Communication and Documentation

The referring hospital bears responsibility for ensuring safe transfer, though planning must be shared between referring and receiving facilities 1:

• Physician-to-physician communication is required, with documented names of accepting physician and receiving hospital 1
• Clear point of transfer must be established—specifically where the patient will be received (ICU, operating room, radiology suite, emergency department, ward) 1
• Medical records and imaging must be copied and accompany the patient 1
• COBRA/EMTALA compliance documentation including informed consent disclosing transfer risks and benefits 1

Staffing Requirements for Transfer

Minimum Qualifications for Accompanying Personnel

A critically ill patient must be accompanied by a clinician with appropriate training, skills, and competencies in managing the specific patient population during transfer 1:

• For brain-injured patients: The accompanying clinician must be able to independently initiate, administer, and modify pharmacology, physiology, and ventilation to minimize secondary brain injury 1
• Must be competent to perform drug-assisted tracheal intubation during transfer if necessary 1
• A dedicated trained assistant should accompany the clinician (operating department practitioner, ICU nurse, or Advanced Critical Care Practitioner) 1

Critical Caveat on Staffing

Staff shortages or need to cancel routine work should never allow transfers to be compromised or substandard 1. Consultant time for transfers must be built into manpower projections, and shift arrangements must account for this work 1.

Transfer Agreements and Protocols

Pre-Established Institutional Agreements

Local transfer plans must be agreed upon between referring hospitals and receiving facilities in advance, with regular review and audit 1:

• Designated consultants at both facilities with overall responsibility for transfers, with time recognized in job plans 1
• Which patients require immediate emergency transfer, with time-sensitive cases prioritized appropriately 1
• Primary contact information with alternatives if unavailable 1
• Protocols for unexpected clinical changes before or during transfer 1

Transport Logistics

Ambulance service contact must include clear information about urgency, crew qualifications, and vehicle requirements (ICU-equipped, bariatric) 1:

• Most transfers by land ambulance; air transport for longer distances 1
• Standards of care expected and training level required for accompanying team 1

Special Considerations

When Transfer Should NOT Be Delayed

For brain-injured patients requiring emergency surgery, admission should never be delayed—lack of critical care beds is not a reason for refusing admission 1. The commonly accepted target is surgery within 4 hours of injury, though this is not evidence-based 1.

Patients with acute ischemic stroke for thrombectomy should be transferred without delay; those with anterior circulation stroke rarely need airway intervention 1.

Facilities Without Appropriate Resources

Hospitals should electively admit only patients for whom they have appropriate resources (physical space, size-appropriate equipment, qualified staff) 1. When these resources are unavailable, policies must assist with determining appropriate triage, consultation, and referral decisions 1.

Common Pitfalls to Avoid

• Never use laryngeal mask airways for critically ill patients undergoing transport—only endotracheal tubes or tracheostomy are acceptable 1
• Never use neuromuscular blocking agents without sedation and analgesia 1
• Do not delay transfer for nonessential testing and procedures 1
• Ensure adequate medical indemnity insurance for transfers, with physicians as members of medical defense organizations 1
• Mobile phone possession by transfer team is mandatory for urgent communication 1