Clinical & Non-Clinical/Capacity Transfers
Critically ill patients are inherently unstable, and transferring them between hospitals presents potential clinical risks ('Why worry about transfers?').
Clinical transfers are necessary in order to provide definitive care at a specialist centre, when a patient has presented elsewhere.
This is widely understood for longstanding tertiary specialities such as cardiothoracic, neurosugery/neurology, spinal, and burns; but it is also increasingly recognised that formerly "general hospital" specialities such as acute stroke, emergency abdominal surgery, paediatrics, and major arterial surgery also have better outcomes when concentrated in centres of excellence.
This means clinical transfers of critically ill patients are likely to increase, but such transfers remain high-risk. Ways to minimise this risk include pre-hospital decision-making (so that the patient is admitted to the appropriate centre directly), and rationalisation of emergency department locations.
Capacity or Non-clinical transfers are those made necessary by local capacity shortfall. In other words, the patient would not need to be transferred for clinical reasons, but the only available critical care resource is at another location.
Capacity transfers are an avoidable risk which can be reduced by local and networked planning based on audit and feedback. Providing insufficient local critical care beds may be a saving for an individual provider, but may increase cost to the overall health economy by causing increased diverts. Capacity or Non- clinical transfers fell by 50% from one year to the next after the Network transfer audit began.