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Repatriation From Tertiary Units

The Network recognises a collective duty of care among all its units, to give full consideration and appropriate priority to 'repatriating' tertiary referral patients to general units nearer home, once they no longer need specialist input. This applies to patients in all tertiary centres, inside or outside the Network.

Rationale

  • The importance of early access to tertiary specialist units, is now well established. As well as classic tertiary specialities such as neurosurgery or cardiothoracic surgery, the principles of fast access and escalation also apply to more recently 'regionalised' time-critical, interventional specialities such as major trauma, stroke, major arterial surgery, and interventional cardiology.
  • In all of these areas, critical care capacity may represent a bottleneck which restricts ability to accept new referrals. Tertiary unit critical care is in turn affected by those patients who are transferred to regional specialist centres and who need prolonged critical care after their primary specialist intervention.
  • Repatriating these patients to referring general hospitals, once stable but potentially while still needing critical care, will help maintain tertiary access for new patients, and is also likely to be in the wider best interests of the repatriated patient.
  • Step down, rehabilitation, domicilary support, integration with primary care, and ability of friends and families to visit and support the patient, may all be easier at the hospital nearer to the patient's home.

Patients undergoing 'repatriation' should be assessed as stable for transfer, and subject to careful ICU-to-ICU handover.

Where patients are being repatriated closer to home in the expectation of poor outcome or prolonged dependency (e.g. post neurological injury), it is expected that the family will have been given a realistic prognosis prior to transfer, for consistency of message between units.

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