Intra and Inter Hospital

Patient Transfer
Moving and Transferring Patient Covid-19

AAW-2020
Key Elements of Patient Transfer
• Decision to transfer and communication
• Exposure of the patient and the staff to additional risk and additional
expense for the relatives and the hospital

• A written and informed consent of patient's relatives along with the

reason to transfer is mandatory

• A direct communication between the transferring and receiving facility

should be undertaken with sharing of complete information on
patient's clinical condition, treatment being given, reasons for transfer,
mode of transfer and timeline of transfer, in a written document.

• Pre Transfer Stabilisation and Preparation

• During the preparation, patient's A, B, C and D, i.e., airway, breathing,
circulation and disability, should be checked, and any associated
preventable problems should be corrected
• Mode of Transfer
• Ground Transport
• BLS Transport
• ALS Transport
• MICU
• Air Transport
• Accompanying the Patient

• Level 0: It includes the patients who can be managed at the level of ward in a hospital
and are usually not required to be accompanied by any specialised personnel

• Level 1: It includes those patients who are at risk of deterioration in their condition
during the transfer but can be managed in an acute ward setting with support from
critical care team. These usually have to be accompanied by a paramedic or a trained
nurse

• Level 2: It includes patients who require observation or intervention for failure of single
organ system and must be accompanied by trained and competent personnel

• Level 3: It includes patients with requirement of advanced respiratory care during the
transport with support of at least two failing organ systems. These patients have to be
accompanied by a competent doctor along with a nurse and a paramedic.
• Equipment, drugs, and monitoring
• The transfer ambulance must be equipped with all the drugs
and instruments required for airway management, oxygenation,
ventilation, haemodynamic monitoring and resuscitation
• The minimum standard of monitoring recommended for patient
transfer includes continuous electrocardiogram monitoring,
non-invasive blood pressure, oxygen saturation, end-tidal
carbon dioxide (in ventilated patients) and temperature.
• Documentation
• The documentation should always be clear at all stages of
transfer.
• It must include the patient's condition, reason to transfer,
names and designation of referring and receiving clinicians,
details and status of vital signs before the transfer, clinical
events during the transfer and the treatment given.
PHYSIOLOGICAL ALTERATIONS DURING TRANSPORT

• Noise
• Vibration
• Acceleration and gravitational forces
• Temperature and humidity
• Altitude
Complications
During
Transport
Infection Prevention during
Transfer and Transport of
Patient with Covid-19
Roles and responsibilities of key stakeholders

Coordinating Body
• Conduct mapping and real-time oversight of available resources
• Ensure that all staff of designated medical facilities and patient
referral services are adequately trained in appropriate IPC
• Coordinate safe referral and transfer between and within health
facilities and ambulatory service providers
Technical guidance for safe transfer
• All stakeholders involved in referral and transfer should have the
same SOP manual with clearly defined roles and responsibilities
and a communication plan
Service providers for transfer and transport

• Respond to the coordinating body for arranging

• safe transfer
• Allocate equipment and staff
• Monitor the patient’s condition and provide necessary care
• Provide coordinated handover
• Clean and disinfect the vehicle and equipment after each transfer
• Optimize ventilation in vehicles during transport.
• Designated health facilities
• Receive referred patients, coordinating closely with service
providers for transfer and transport and the coordinating body
• Where possible, patient movement within the facility should be
kept to an absolute minimum
• Make essential resources (e.g. alcohol-based handrub)
available for disinfection of ambulance staff and vehicles
transferring patients with possible infection before leaving the
health facility.
IPC measures for front-line health facilities
• Designate a well-ventilated waiting area and allow for more than
1-metre distance between patients within the waiting area.
• Provide medical masks to patients with respiratory symptoms.
• Apply standard, contact and droplet precautions during
counselling, sampling for upper respiratory tract specimens and
treatment procedures.
• Take airborne precautions when aerosol-generating procedures
are performed
Preparation for transfer

• Stabilize the patient’s condition.

• Communicate with the emergency transfer centre and receiving
hospital regarding the patient’s condition and estimated time of
arrival.
• Secure informed consent from the patient or a family member.
• Designate trained staff to accompany the patient.
• Set up basic and additional equipment and medication.
• Prepare a referral letter.
Moving patients within the same hospital

• should be limited to essential purposes only

• Staffs must be informed that the patient has possible or
confirmed COVID-19
• minimise the dispersal of respiratory droplets when this can be
tolerated and providing this does not compromise clinical care
• Patients must not wait in communal areas
• patients should be placed at the end of clinical lists
Patient Transfer by Train
Transfer from primary care/community settings

• Should follow EMS regulation standard (SPGDT)

• the ambulance service should be informed of the infectious
status of the patient
• Staff of the receiving ward/department should be notified in
advance of any transfer and must be informed that the patient
has possible or confirmed COVID-19
Moving patients between different hospitals

• Only if medically necessary for specialist care arising out of

complications or concurrent medical events

• Should follow EMS regulation standard (SPGDT)

• the ambulance service should be informed of the infectious
status of the patient

• Staff of the receiving ward/department should be notified in

advance of any transfer and must be informed that the patient
has possible or confirmed COVID-19
Take Home Messages