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

Assuming you mean UK adult critical care transfers (intra-hospital and inter-hospital), the key requirement is that the patient is managed as a critical care patient throughout, with the same standards of care whether moving within or between hospitals [1].

Core standards

• Use a standardised transfer system with checklists, staffing and equipment [2][1].
• Have regional / trust transfer policies, with a named transfer lead and governance/audit arrangements [1].
• Do a documented senior risk assessment before transfer, and use it to decide escort level [1].
• The decision to transfer/accept should be made by the appropriate consultants at both ends [1].
• Time-critical transfers must not be delayed by lack of a critical care bed [1].

Staffing

• Higher-risk patients need two appropriately trained, competent and experienced clinical escorts who can continue critical care and manage unexpected events [1].
• Acute hospitals should have a plan to provide two suitably trained clinicians 24/7 for inter-hospital transfer [1].
• Escorts must have specific transfer training, supervised experience and demonstrated competencies; untrained staff should not transfer unsupervised [1].
• NHS ambulance crew must not be used as the second clinical escort in critical care transfer [1].

Equipment

• Use a CEN-compliant transfer trolley with equipment securely mounted [1].
• Monitoring and equipment must be suitable for the transfer environment and securely fixed; monitors, ventilator displays and syringe drivers should be visible to staff [1].
• Equipment should be serviced annually and checked daily/weekly as appropriate, with written records [1].
• Have dedicated transfer bags and dedicated medication bags for all transfers; these should be checked regularly [1].
• Provide adequate oxygen, a functioning inverter if required, and ensure all equipment is securely stowed in the vehicle [1].
• Maintain continuous monitoring appropriate to the patient’s acuity; for level 3 patients this includes ECG, blood pressure, SpO₂, ETCO₂ and temperature [1].
• Patient must be secured with an appropriate harness/belt system [1].

Clinical preparation

• Optimise/resuscitate and stabilise before transfer where possible [1].
• If airway/ventilatory/neurological compromise is present or anticipated, intubate and ventilate before transfer [1].
• Ensure adequate vascular access; at least two peripheral IVs or one multi-lumen central venous access [1].
• Have enough bolus/infusion drugs for at least twice the planned transfer duration [1].

Documentation

• Complete a documented pre-transfer risk assessment [1].
• Use a checklist for each stage: preparation, departure, transfer and post-transfer [1].
• Intra-hospital transfers should be documented in the patient’s notes [1].
• Inter-hospital transfers outside dedicated transfer services should use the Critical Care Network transfer form and include the minimum mandatory dataset [1].
• Copy or electronically transmit patient notes, and use an appropriate transfer letter/handover document [1].
• Maintain a documented record of observations and events during transfer [1].
• Ensure a formal multidisciplinary handover occurs on arrival [1].
• Document the decision about emergency driving / blue lights if used [1].