What is the nursing standard of care for effectuating inter-hospital transfers as the transferring hospital?

Nursing Standard of Care for Inter-Hospital Transfers as the Transferring Hospital

Nurses at the transferring hospital must ensure direct nurse-to-nurse communication with the receiving facility, complete comprehensive documentation including all medical records and test results, maintain the same level of physiologic monitoring during transport as provided in the ICU, and accompany critically ill patients with at least one other trained team member while carrying full resuscitation equipment and medications. 1

Pre-Transfer Communication Requirements

The nursing standard mandates structured communication before any transfer occurs:

• Nurse-to-nurse report is mandatory either before departure or immediately upon arrival at the receiving facility to ensure continuity of care and prevent critical information loss during handoff 2, 3
• This communication must review the patient's current condition, vital signs, all interventions performed, and the active treatment plan 1
• The receiving location must confirm readiness to receive the patient for immediate care before transport begins 1
• Notify all relevant healthcare team members (respiratory therapists, hospital security) as appropriate 1

Common pitfall: Nurses often encounter situations where transferred patients arrive without necessary transfer records (86.9% of the time according to accepting physicians), which poses significant patient safety risks 4. To avoid this, use a standardized checklist to ensure all documentation accompanies the patient.

Patient Stabilization Before Transfer

The transferring nurse must ensure appropriate stabilization occurs before departure:

• Secure intravenous access and evaluate airway security, intervening if deterioration is likely en route 2, 5
• Initiate fluid resuscitation and inotropic support if needed 2
• Place nasogastric tube for patients with ileus, obstruction, or requiring mechanical ventilation 2
• However, do not delay transfer for nonessential testing or imaging that won't change immediate management 2, 5

The Society of Critical Care Medicine emphasizes that while stabilization is important, complete optimization may only be possible at the receiving hospital, and time-sensitive conditions should not be delayed for prolonged stabilization attempts 6, 5.

Required Accompanying Personnel

A minimum of two people must accompany every critically ill patient during transfer 1:

• One must be a nurse who has completed competency-based orientation and meets critical care nursing standards 1
• The second person may be a respiratory therapist, registered nurse, critical care technician, operating department practitioner, ICU nurse, or Advanced Critical Care Practitioner 1
• A physician with training in airway management, advanced cardiac life support, and critical care must accompany unstable patients 1

For pediatric transfers, personnel with pediatric-specific training and experience should ideally comprise the transport team 2.

Essential Equipment and Medications

The transferring nurse must ensure the following equipment accompanies every patient without exception 1:

Monitoring Equipment (Mandatory for All Patients):

• Blood pressure monitor (or standard cuff) 1
• Pulse oximeter 1
• Cardiac monitor/defibrillator 1
• Memory-capable monitor when available for data review 1

Airway and Respiratory Equipment:

• Complete airway management equipment sized appropriately for the patient 1
• Oxygen source with supply adequate for projected needs plus 30-minute reserve 1
• Portable mechanical ventilator with airway pressure monitoring, minute volume monitor, and disconnect alarm 1

Medications (Must Accompany Every Patient):

• Basic resuscitation drugs including epinephrine and antiarrhythmic agents 1
• Supplemental medications such as sedatives and narcotic analgesics as indicated 1, 2
• Ample supply of continuous drip medications regulated by battery-operated infusion pumps 1
• Comprehensive pediatric-specific medications for pediatric transfers 2

Critical equipment check: All battery-operated equipment must be fully charged and capable of functioning for the entire transport duration 1. Equipment should be dedicated solely for transfers, serviced per manufacturer guidance, and checked immediately before each transfer 1.

Monitoring During Transport

All critically ill patients must receive the same level of basic physiologic monitoring during transport as they had in the intensive care unit 1:

• Continuous pulse oximetry 3, 5
• Continuous electrocardiographic monitoring 3, 5
• Regular blood pressure measurements 3, 5
• Regular respiratory rate measurements 3, 5

Selected patients based on clinical status may require additional monitoring of intra-arterial blood pressure, central venous pressure, pulmonary artery pressure, intracranial pressure, or capnography 3, 5.

Documentation Requirements

The transferring nurse must ensure comprehensive documentation accompanies the patient 3:

• Complete copy of the medical record 3
• Patient care summary 3
• All relevant laboratory results 3
• All radiographic studies 3

Research shows that 86.9% of transferred patients arrive without necessary transfer records, creating substantial safety risks 4. The Association of Anaesthetists recommends using standardized transfer forms and documentation tools that integrate patient assessment with procedural guidelines 7.

Quality and Safety Considerations

The nursing role in transfer safety is critical because:

• Critically ill patients are at increased risk of morbidity and mortality during transport, with adverse events occurring in up to 68% of transports and serious adverse events requiring intervention in 4.2-8.9% of cases 5
• Cardiac arrest during transport occurs in 0.34-1.6% of cases 5
• Poor transfers result in higher mortality rates, longer lengths of stay, and higher hospitalization costs 8

Each hospital must have a formalized written transport plan addressing communication, personnel, equipment, monitoring, and documentation 1. This plan should be developed by a multidisciplinary team and evaluated regularly using standard quality improvement processes 1.

Common Nursing Pitfalls to Avoid

• Inadequate handoff communication: Nurses describe frequent challenges with information exchange and team communication during transfers, with no standardized processes to coordinate care before or at patient arrival 8. Use structured communication tools and ensure direct nurse-to-nurse contact.

• Delayed physician evaluation: Nurses report that "our hands are tied until your doctor gets here," with transferred patients sometimes arriving without timely identification of or access to admitting clinicians 8. Confirm accepting physician availability before departure.

• Information decay: Multiple studies show that information is lost during handoffs, particularly in high-acuity areas like the ICU 9. Use written documentation in addition to verbal reports to prevent information loss.

• Equipment failure: Ensure all equipment is fully charged, tested immediately before transport, and compatible with ambulance oxygen and power supplies 1.

• Unrealistic expectations: Transferred patients frequently arrive with unrealistic expectations of care (77.2% of responses from accepting physicians) 4. Ensure clear communication about the receiving facility's capabilities and the patient's anticipated care needs.