NENC London Adult Critical Care Network Transfer audit

Why monitor Role of network to monitor transfers Documentation Medico legal document Audit to learn from incidents Developing the training and competencies Medico legal document (Aim to maintain the same professional and personal conduct that would be considered ‘good clinical practice’ in the normal working environment. A legal record of the transfer process being an essential piece of documentation. Audit to learn from incidents ( shared learning,, Developing training and competencies on going process Standardising policy Standardising policy

Background New books printed and distributed in 2018 3 parts 1 to patient notes (white) 1 goes with patient (blue) 1 form goes to the Network (pink) Looking into developing and printing new books

Method in collecting data Looking at the following from 478 pink sheets Demographics Level of care given prior to transfer Incidents Working diagnosis and organ supported Status Did not take in count PMH, age,

Results Level of care given on transfer 13 units - 478 transfer forms since July 2015 Barnet – 31 Homerton – 119 Newham – 53 North Mid – 87 Queens – 5 Queens Romford – 2 King Georges - 23 Royal Free – 23 Royal London - 31 St Barts - 35 Whipps Cross - 34 Whittington - 7 UCLH - 1

Results 13 units - 478 transfer forms since July 2015 Level of care on transfer in %

Results Working diagnosis/organ support on transfer

Working diagnosis/organ support transfer % Results Working diagnosis/organ support transfer % Majority was transfer to specialist centres neuro, cardio, liver… However 40% not recorded

Status of transfers - total 478 Results Status of transfers - total 478 Emergency – 226 Urgent - 41 Very urgent - 87 Elective - 84 Non clinical – 16 Not recorded – 63 Repatriation – 51 Tertiary referrals - 18 With regards to status of transfer only 5 were non clinical probably due to bed shortage but no evidence as reason not given

Results Incidents 22 incidents 2 linked to equipment failure 13 incident recorded but no reason given 7 patient deterioration very little information given with regards to incidents

Conclusion/recommendation Level of care missing on previous audit 5 %, now 3% Incidents 6.5 % where 4.6 % was due to patient deterioration Working diagnosis/organ support 25% missing vs 40 % that was recorded on previous audit Status of transfer 38% emergency vs 40% from previous audit, 11% vs 7 % not recorded We are not able to trace down many information therefore we need to concentrate more on educating staff on documenting relevant information on transfer form

Recommendation New books distributed to all ITU units and A/E Educate all units (fill out the forms, transfer training..) On going project