[Interhospital transport of intensive care patients in Lower Saxony : statewide need-based and effective management]

[Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein]

BACKGROUND

The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles.

OBJECTIVE

To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein.

MATERIAL AND METHODS

Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022.

RESULTS

Of a total of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389 IHT (61.4%) were managed by specialized ambulances, 875 (38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with a higher level of medical care.

CONCLUSION

Emergency physician-assisted IHT are a relevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. A relevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.

[Interhospital critical care transport]

Critically ill patients in need of specialized diagnostic or therapeutic procedures, but are being cared for in a hospital without such equipment, have to be transferred to appropriate centers without discontinuation of current critical care (interhospital critical care transfer). These transfers are resource intensive, challenging, and require high logistical effort, which must be managed by a specialized and highly trained team, predeployment planning and efficient crew-resource management strategies. If planned adequately, interhospital critical care transfers can be performed safely without frequent adverse events. Beside routine interhospital critical care transfers, there are special missions (e.g., for patients in quarantine or supported by extracorporeal organ support) that might require adaption of the team composition or standard equipment. This article describes interhospital critical care transport missions including their different phases and special circumstances.

[Interhospital critical care transport]

Critically ill patients in need of specialized diagnostic or therapeutic procedures, but are being cared for in a hospital without such equipment, have to be transferred to appropriate centers without discontinuation of current critical care (interhospital critical care transfer). These transfers are resource intensive, challenging, and require high logistical effort, which must be managed by a specialized and highly trained team, predeployment planning and efficient crew-resource management strategies. If planned adequately, interhospital critical care transfers can be performed safely without frequent adverse events. Beside routine interhospital critical care transfers, there are special missions (e.g., for patients in quarantine or supported by extracorporeal organ support) that might require adaption of the team composition or standard equipment. This article describes interhospital critical care transport missions including their different phases and special circumstances.

Intensivverlegungen in der COVID-19-Pandemie – eine Analyse aus einem landesweit koordinierten Intensivverlegungssystem

Zusammenfassung Diese Analyse untersucht den Einfluss der COVID-19-Pandemie auf ein landesweites Intensivverlegungssystem.

Material und Methoden Um die Auswirkungen der COVID-19-Intensivtransporte zu analysieren, wurden retrospektiv 2 17-monatige Betrachtungszeiträume ausgewählt.

Ergebnisse Im Untersuchungszeitraum wurden 5291 Intensivtransporte durchgeführt. Von diesen Transporten waren 525 Intensivtransporte mit COVID-19, wovon 474 (90,3%) per ITW und 51 (9,7%) mittels Luftrettungsmitteln durchgeführt worden sind.

Diskussion Die Gesamteinsatzzahlen wiesen einen initialen Rückgang auf, der sich im Verlauf wieder umkehrte. Es zeigte sich, dass die bodengebundenen Intensivtransporte anstiegen, während die Einsatzzahlen in der Luftrettung im gesamten Zeitraum signifikant unter dem Niveau des Vergleichszeitraums lagen. Insgesamt fand sich in der Subgruppe der COVID-19-Patienten eine erhöhte Erkrankungsschwere und intensivmedizinischer Versorgungsaufwand.

[Appropriate allocation of resources for interhospital transfer in emergency medical service-is a physician in the dispatch center helpful?]

BACKGROUND

The number of interhospital transfers is constantly increasing because of specialization of medical facilities, capacity balancing between intensive care units as well as earlier rehabilitation procedures. This leads to an increase in requests for emergency physicians to accompany patient transfers. This study investigated whether clarification of interhospital transport by an emergency physician at the dispatch center can optimize the use of emergency services resources.

METHOD

All transport clarifications performed by a tele-emergency physician between 1 January 2018 and 31 December 2019 were retrospectively analyzed as well as the transport request forms. Furthermore, all data on the number and alarmed rescue resources for interhospital transfers in the city of Aachen from 2013 onwards were exported from the dispatch center databank and included in the evaluation.

RESULTS

In total 2333 requests for interhospital patient transfers from 2018 and 2019 were analyzed as well as 10,923 transports recorded from 2013 to 2019. The number of patient transfers accompanied by an emergency physician from 2013 to 2019 was significantly reduced from 786 (68.2%) to 495 (30.5%, p > 0.001). The correct resources of rescue vehicles and staff was requested in 1816 cases (77.8%). The urgency of emergency patient transfers was correctly evaluated in 567 (89.2%) cases. In total 526 assignments were carried out without an emergency physician and 315 of these patients were accompanied by a tele-emergency physician during transfer.

CONCLUSION

The immediate clarification of interhospital transport requests by an emergency physician at the dispatch center leads to a significant reduction in unnecessary medical accompaniment of patient transfers. The choice of an appropriate transfer vehicle and staff should not be left to the requesting hospital physician alone.

[Air rescue: current significance and practical issues]

Germany has a nationwide and powerful helicopter emergency medical services system (HEMS), which executes primary rescue missions and interhospital transfer of intensive care patients. In recent years the range of HEMS missions has become modified due to demographic changes and structural changes in the healthcare system. Furthermore, the number of HEMS missions is steadily increasing. If reasonably used air rescue contributes to desired reductions in overall preclinical time. Moreover, it facilitates prompt transport of patients to a hospital suitable for definitive medical care and treatment can be initiated earlier which is a particular advantage for severely injured and critically ill patients. Because of complex challenges during air rescue missions the qualifications of the HEMS personnel have to be considerably higher in comparison with ground based emergency medical services.