Where a ‘time-critical’ condition exists and care cannot be provided at the patient's current hospital, traditional ‘refer and accept’ pathways of care may delay immediate transfer. This paper describes how to identify time-critical patient groups and the sources of delay. This enabled a local clinical network to redesign the transfer process, resulting in the removal of specialist teams from the transfer decision-making process, changing the process from ‘refer and accept’ to ‘send and inform.’ In cases where referral to and acceptance by specialist teams were removed from the decision-making pathway, a median time saving of 1 hour 38 minutes was achieved.
HarrisonDBarrattHRowanKRaineR. Effect of non-clinical inter-hospital critical care unit to unit transfer of critically ill patients: a propensity-matched cohort analysis. Crit Care2012;16: RR.
2.
Intensive Care Society. Guidelines for the transport of the critically ill adult (3rd Edition 2011).Intensive Care Society; London: 2011 Available from: http://www.ics.ac.uk/ics-homepage/guidelines-standards/ Accessed 24 Feb 2014.
3.
BultersDBelliA. A prospective study of the time to evacuate acute subdural and extradural haematomas. Anaesthesia2009;64: 277–81.
FreshwaterESDickinsonPCrouchRExtending access to specialist services: the impact of an onsite helipad and analysis of the first 100 flights. Emerg Med J2014;31: 121–25.
6.
NHS Institute for Innovation and Improvement (Great Britain). The handbook of quality and service improvement tools.Coventry: NHS Institute for Innovation and Improvement; 2010.
7.
National Institute for Health and Care Excellence. NICE Clinical Guideline 56 Head Injury [Internet]. NICE; London: 2007.
