Inter-hospital transfers, Emergency Department management of

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In-patient transfers

Definition: These are patients already admitted to an in-patient hospital bed elsewhere being transferred for specialist input at RHC.

In hours (Monday- Friday 9am to 5pm)

During these hours inter-hospital transfers should go directly to their allocated ward bed and do not come through the Emergency Department (ED).

Out of hours

Ward bed ready (majority of cases):

The patient will be greeted at triage in the ED and a set of observations recorded on a CEWS chart (or last transfer observations if taken within the last 10 minutes). If stable during transfer, with no significant change in observations and no concerns raised by the ED nurse/transfer staff, the patient should proceed directly to the ward for handover to take place there.

Ward bed not ready (exceptional cases):

The patient will be triaged in the ED and allocated to a space in the Clinical Decision Unit (CDU) or ED accordingly, with hand over to the responsible CDU/ED staff. The accepting specialty will be paged from triage and should attend promptly to review their patient.

Resuscitation required:

If there has been an unforeseen complication or deterioration during transfer, the patient will be taken immediately into resus and attended by ED staff. The accepting specialty will be contacted and expected to attend.

ED transfers from outwith RHC

Definition: These are patients coming directly from another ED or Assessment Unit at any time, irrespective of receiving specialty.

All transfers from an ED or Assessment Unit outwith RHC for specialty review will be triaged in the ED and allocated to a space in the ED accordingly. The accepting specialty will be informed of their arrival. These patients (excluding head injuries) will be seen by the accepting specialty staff. However, they will be attended by ED staff if any immediate concerns are identified at triage.

Transfers arriving with a Retrieval Team

Any patient being brought to RHC by a retrieval team, including ScotSTAR MUST have been discussed with and accepted by the admitting consultant from the relevant accepting specialty, at which time an appropriate venue for specialty review in RHC should be agreed.

Patients arriving with a retrieval team to an identified inpatient bed, including CDU and PICU, should proceed directly to that bed and DO NOT require to stop or be triaged in the ED. If the child is to be reviewed in the ED (guidance above applies) the ED co-ordinator should be informed by the accepting consultant and given details of which clinician will review them on arrival and how they can be contacted.

In the event of an unforeseen complication or deterioration during transfer, the ED should be notified as soon as possible and the patient will be taken immediately into resus and attended by ED staff. The accepting specialty will be contacted and expected to attend.

In the event that a child arriving with a Retrieval Team requires a ‘Trauma Pause’ please follow the trauma team activation procedures found on the ED guidelines page on Staffnet or via the link below.

Trauma team activation pathway

Editorial Information

Last reviewed: 01 July 2018

Next review: 01 July 2020

Author(s): Marie Spiers

Reviewer Name(s): ED Guidelines Group