What standards, staffing, equipment and documentation are required when transferring a critically ill adult within or between hospitals?

For UK adult critical care transfer, the current Intensive Care Society / FICM guidance says critically ill patients should be managed as critical care patients, with the same standards of care for intra-hospital and inter-hospital transfer; NICE similarly recommends standardised systems of care including checklists, staffing and equipment for transfers of critically ill patients [1][2].

1) Core standards

• Use a standardised transfer system with protocols/checklists, trained staff and appropriate equipment [1][2].
• The transfer must not reduce the standard of care compared with ICU-level care [1].
• Transfer decisions should be made by appropriate consultants in both referring and receiving hospitals; time-critical lifesaving transfer must not be delayed by bed availability [1].

2) Staffing

• A senior clinician should perform and document a pre-transfer risk assessment [1].
• Staff undertaking transfer must be trained, competent and experienced in critical care transfer; no unsupervised transfer until competency is demonstrated [1].
• Higher-risk patients should have two appropriately trained, competent escorts able to continue critical care and manage unexpected events [1].
• A plan should exist for 24/7 provision of two suitably trained clinicians for inter-hospital transfer [1].
• NHS ambulance crew must not be used as the second clinical escort in critical care transfer [1].
• Networks/trusts should have a named lead consultant for transfer covering training, equipment, governance and quality assurance [1].

3) Equipment

• Use a CEN-compliant critical care transfer trolley with equipment securely mounted [1].
• Equipment must be suitable for the transfer environment, securely fixed, and regularly checked/serviced with written records [1].
• Trusts should have dedicated transfer equipment and drug bags [1].
• Equipment bags should be checked regularly to ensure items are present and in date [1].
• Clinical escorts should have adequate PPE [1].
• For the ambulance journey, ensure the transfer team liaises about sufficient oxygen and a functioning inverter; all equipment should be securely stowed [1].

4) Monitoring / clinical care in transit

• Apply continuous monitoring to ICU-equivalent standards during every intra- and inter-hospital transfer [1].
• Minimum monitoring should include at least:
  • ECG
  • blood pressure
  • SpO₂
  • temperature
    
    For ventilated/Level 3 patients, capnography (ETCO₂) is required [1].
• Monitors, ventilator displays and syringe drivers should be visible to accompanying staff [1].

5) Documentation

Required documentation should include:

• Documented pre-transfer risk assessment [1].
• A checklist for preparation/departure/post-transfer [1].
• A transfer letter or handover document with key information [1].
• Copied or electronically transmitted notes [1].
• Documented record of observations and events during transfer [1].
• For intra-hospital transfer, complete the transfer in the patient’s notes [1].
• For inter-hospital transfer outside dedicated ACCTS, use the relevant Critical Care Network transfer form and include the minimum mandatory dataset [1].
• Medication prescription and administration documentation must be adequate, and controlled drugs accounted for at the end of the transfer [1].
• Keep records of all transfers and ensure formal multidisciplinary handover on arrival [1].

6) Governance / service organisation

• Trusts and networks should have governance arrangements covering audit, incident reporting and review for all transfers, including intra-hospital transfers [1].
• Patients and next of kin should be kept informed and given appropriate written information [1].