Guideline Health Service Directive

Transcription

1 Guideline Health Service Directive Guideline QH-HSDGDL-025-3:2014 Effective Date: 17 January 2014 Review Date: 17 January 2016 Supersedes: qh-hsdptl-025-3:2012 Patient Access and Flow Health Service Directive Guideline for Inter Hospital Transfers 1. Purpose This guideline provides recommendations regarding best practice for the transfer and referral of patients into, out of and between Queensland Health Hospitals, including between and within Hospital and Health Services. The Guideline does not cover the road transfer of critically ill patients. 2. Scope This Guideline applies to all Hospital and Health Services. This Guideline applies to all Hospital and Health Service employees and all Department of Health employees working in or for Hospital and Health Services. This Guideline also applies to all organisations and individuals acting as an agent for Hospital and Health Services (including Visiting Medical Officers and other partners, contractors, consultants and volunteers). 3. Guideline for process for the transfer of patients into, out of and between Queensland Health hospitals 3.1 Over Arching Points For the purposes of this document the term Inter Hospital Transfer refers to any patient transported directly from one hospital to another on the advice of clinical staff, whether admitted to either hospital or not. This includes those patients defined under the National Health Data Definitions Dictionary as Inter Hospital Transfer and Inter Hospital Referral No patient should be transported out of any hospital without the knowledge of the staff member responsible for bed management and responsible Medical Officer at the accepting hospital and the identification of a suitable available bed or treatment area The Emergency Department Consultant (or delegate) on duty is responsible for all patients treated in the Emergency Department. No incoming Inter Hospital Transfer (IHT) patient should be transferred into the Emergency Department without the prior acceptance of the Emergency Department Consultant (or delegate). Effective From: <date> Page 1 of 12

2 3.1.4 Where appropriate, IHT patients should be transported directly to an available inpatient bed unless they have an agreed clinical requirement for Emergency Department treatment or have deteriorated in transit, necessitating Emergency Department intervention. 3.2 Hospital and Health Services Chief Executive Officers (HHS CEOs) Responsibilities IHTs may operate within or between Hospital and Health Services HHS CEOs should ensure that: Formalised intra-network referral arrangements exist for the IHT of patients. Formalised inter-network referral arrangements exist for the IHT of patients. The electronic recording of IHTs accurately reflects services provided. Each hospital has a nominated staff member responsible for bed management at all times. This role may be performed alongside other duties. This person should be referred to as the Bed Manager in this document. Each hospital has a designated generic address for bed management and that this is continuously monitored by the Bed Manager. Bed Managers have write access to the Emergency Department Information System (EDIS) Expects Screen, where EDIS is available. A link is placed on each hospital s intranet home page to the Inter Hospital Transfer Request Form. The EDIS Type of Visit is completed accurately. The benchmark for numbers of incoming IHT patients with an EDIS Type of Visit of Hold is achieved. 3.3 Communication and Handover Overall responsibility for IHTs should be taken by the referring and accepting Consultants, where employed, or most senior Medical Officer available in facilities where consultants are not employed Hospital and Health Services or individual Consultants may have in place pre arranged authorisation procedures for the referral and acceptance of IHTs by other clinical staff as necessary Clinical Handover from referring to accepting hospital must be completed by the most senior Medical Officer or clinician available, who, in facilities in which they are employed, should be at Registrar level or above The referring clinician should complete the electronic Inter Hospital Transfer Request Form (Appendix B). On submission this form is automatically sent to the Bed Managers at the accepting and referring hospitals Referring clinicians should ensure that available risk assessment tools are utilised to determine risk levels prior to completing the Inter Hospital Transfer Request Form. Effective From: 17 January 2014 Page 2 of 12

3 3.3.6 The accepting Medical Officer should contact the accepting Bed Manager as soon as Clinical Handover is complete to inform them of the planned transfer The accepting Bed Manager should call the referring Bed Manager within one hour of receiving the Inter Hospital Transfer Request Form to confirm receipt of the and notify of time and date of bed availability Where available, the accepting Bed Manager should enter the patient details, including destination and accepting Medical Officer contact details, into the EDIS Expects Screen to ensure that the patient is directed to the correct area on arrival Referring and accepting Bed Managers should make use of available patient flow software to inform decision making In the event of any disagreement surrounding the IHT, consultation must occur between the referring and accepting Consultants or most senior Medical Officers available and the accepting Bed Manager. If the disagreement remains unresolved, this should be escalated to the Executive Director of Medical Services (EDMS) at both facilities In the event that there is not a bed available at the accepting facility within the required time frame, the following steps should be taken: 1. The accepting Bed Manager should confer with the referring and accepting clinicians to determine whether the IHT can be delayed until a bed is available. 2. The referring and accepting clinicians should confer regarding alternative admission routes e.g. discharge home with elective admission the following day. 3. The referring and accepting clinicians should confer to determine whether the patient can be transferred to another facility 4. If the IHT is urgent and the above options have been exhausted, the accepting Consultant or most senior Medical Officer should escalate the issue to the Executive Director of Medical Services IHT negotiations between accepting and referring hospitals should always include an agreement by the referring hospital to receive the patient back as soon as able once the services at the accepting hospital are no longer required or indicated. 3.4 Use of the Emergency Department for Inter Hospital Transfers Incoming IHT patients should only be treated in the ED under the following circumstances: a. Accepted by the ED Consultant (or delegate) for specialist emergency care. b. Unexpected deterioration in transit, as determined by the accompanying paramedic, clinical escort or triage nurse. If a patient is treated in the Emergency Department due to situation (b), the Emergency Department Consultant (or delegate), accepting Medical Officer and accepting Bed Manager should be notified as soon as possible. Effective From: 17 January 2014 Page 3 of 12

4 3.4.2 If an incoming IHT patient is expected to require Emergency Department treatment, the accepting Medical Officer should obtain approval from the Emergency Department Consultant (or delegate) prior to the patient s departure from the referring hospital. 3.5 Transfer Process Patients should be referred to the closest appropriate hospital No patient should be transported out of a hospital until an appropriate treatment space at the accepting hospital has been identified, unless determined to be clinically unstable by referring and accepting clinicians and requiring urgent Up Transfer for specialist services All road IHTs of critically ill patients should be conducted in accordance with the Road Inter Hospital Transfer of Critically Ill Patients Guideline All IHTs requiring the involvement of retrieval teams should be conducted in accordance with the Retrieval Services Queensland Activation Flowchart All IHTs should be conducted in accordance with the Inter Hospital Transfer Flowchart in Appendix A Clinical staff at the referring hospital should ensure that all relevant medical notes and imaging are copied and transported with the patient Any clinical escort for road transfers should be arranged by the clinical staff at the referring hospital and should be determined by the individual needs of the patient and the clinical judgement of the most senior referring clinician. See the table on the following page as a guide only. Effective From: 17 January 2014 Page 4 of 12

5 Doctor And Registered Nurse Actual or potential airway compromise Invasive or non-invasive ventilated patient or the potential need for intubation in transit. Cardiovascular instability Glasgow Coma Score <13 Major trauma Major burns Spinal cord injury Table 1: Clinical escort guideline Registered Nurse Stable patient requiring treatment outside the scope of the available paramedics Inter costal catheter Acute Coronary Syndrome with pain, arrhythmias or unresolved ECG changes Cervical spine immobilisation Severe pain, confusion or distress Involuntary mental health patient (compulsory) Patient dependent on hospital equipment that must be operated by hospital staff and returned to the referring hospital QAS only able to provide single officer crew and patient requiring clinical intervention during transit Taxis at the cost of the referring hospital should be used as the primary means of return of clinical escorts and equipment, where available. In areas without adequate access to public transport, the return of escorts should be negotiated between the QAS and referring hospital in accordance with the Queensland Ambulance Service Queensland Health Authorised Transport Operating Standards Mode of transport for IHTs should be determined by the referring clinician. Transport modes may include: private car, taxi, hospital vehicle, Queensland Police Service vehicle, Queensland Correctional Services vehicle, patient transport road ambulance, paramedic road ambulance, air ambulance or commercial flight Road ambulance transport should be ordered by clinical staff using the Queensland Ambulance Service Road Ambulance Ordering Guide Instructions for (QH) Staff. Urgency of response should be determined using this guide Where air ambulance transport is considered likely to be necessary, the Retrieval Services Queensland Activation Flowchart should be followed. Effective From: 17 January 2014 Page 5 of 12

6 In some rural areas QAS may be unable to provide a double officer crew. In these instances QAS may approach the Queensland Health facility for assistance in providing an escort in line with the Queensland Ambulance Service Queensland Health Authorised Transport Operational Standards In the event that there is disagreement between Queensland Health and QAS staff over the necessity of clinical escorts in rural areas, Queensland Health staff should refer to Retrieval Services Queensland for advice. If the matter remains unresolved, the referring clinician should refer to the Executive Director of Medical Services. 3.6 Documentation Only incoming IHT patients who are treated in the Emergency Department should have their details entered into EDIS. EDIS has three options under the field type of visit for recording these patients: Code Descriptor Example of use Tests IHT for diagnostic testing only Patients requiring diagnostic testing not available at the referring hospital and who are expected to return once tests have been completed IED IHT for ED assessment IHT patients who have been accepted by the Emergency Department Consultant or delegate for assessment and treatment in the Emergency Department or who have deteriorated in transit, necessitating ED intervention. Hold Bed unavailable for accepted IHT or unexpected IHT Table 2: EDIS Type of visit codes for Inter Hospital Transfer patients IHT patients who have been accepted by an inpatient Medical Officer for direct ward admission but for whom there is no available bed on arrival or IHT patients of whom the accepting hospital has no knowledge and is not expecting Once an IHT code has been selected for the type of visit, the referred by field will automatically display other hospital and the user will be prompted to enter the referring hospital. It is mandatory that the referring hospital be correctly entered The EDIS transfer screen should be completed for all outgoing IHT patients leaving the Emergency Department. This should include the destination hospital. Effective From: 17 January 2014 Page 6 of 12

7 3.6.4 All incoming IHT patients should have their Hospital Based Corporate Information System (HBCIS) admission source recorded as either Admitted patient - transferred from another hospital or Non-admitted patient - referred from another hospital. 3.7 Education and training The Hospital and Health Services CEO should ensure that: Clinical and medical staff receive training on Clinical Handover Administrative and nursing staff receive training on the use of EDIS and HBCIS to ensure the accurate identification of IHTs. Nursing and medical staff receive training on the identification of patients who require clinical escorts during IHTs and on the level of escort necessary. Nursing and medical staff who conduct clinical escorts for IHTs are appropriately experienced and qualified to provide the necessary care for the patient and are familiar with transfer equipment. Training for safety and other operational issues occurs on a regular and recurrent basis with due consideration for occupational health and safety and infection control issues. 3.8 Transfers between Queensland Health and Non-Queensland Health Hospitals For IHTs from Queensland Health to Non-Queensland Health hospitals, referring Queensland Health clinical staff should ensure that transport does not occur until confirmation has been received from the accepting hospital Bed Manager and the accepting Medical Officer For IHTs from non-queensland Health hospitals to Queensland Health hospitals, the accepting Queensland Health Medical Officer should inform the referring clinician that transport must not occur until the accepting Queensland Health Bed Manager has contacted the referring hospital Bed Manager to confirm the date and time of bed availability. 3.9 Transfer of Patients Suffering from a Mental Illness The referring clinician should ensure that patients being transferred who are suffering from a mental illness are medically cleared of underlying physical illness prior to transport, unless they require treatment for a concurrent active physical illness The referring clinician and responsible Nursing Team Leader should ensure that all legislative paperwork for involuntary mentally ill patients is completed and transported with the patient, in accordance with the Mental Health Act (2000) Care for Patients Admitted Directly to an Inpatient Unit The accepting Medical Officer should ensure that all patient details, including a plan of care and expected date and time of arrival, is communicated to all other relevant inpatient medical team members prior to the arrival of the patient. Effective From: 17 January 2014 Page 7 of 12

8 To ensure patient safety, Hospital and Health Services should put in place mechanisms at each accepting hospital to confirm that patients who are to be admitted directly to inpatient ward beds are clinically appropriate for inpatient admission once they have arrived at the hospital The Nursing Team Leader should contact the accepting Medical Officer on arrival of the patient at the inpatient unit. If this senior Medical Officer is unavailable, the identified delegate or Medical Officer responsible for the patient s specialty should be contacted Incoming IHT patients should receive a two tiered nursing assessment within 30 minutes of arrival on the unit. This consists of assessment by the initial accepting nurse followed by assessment by the Nursing Team Leader The accepting Medical Officer should ensure that a full medical assessment is completed within two hours of the patient s arrival Nursing staff may use medication and fluid orders from the referring hospital, as long as this is a Queensland Health facility, until assessment by a Medical Officer at the accepting hospital has been completed and revised orders issued If at any point the Nursing Team Leader has concerns regarding the patient s condition and is unable to initiate a response from the accepting Medical Officer or delegate, standard local emergency procedures must be referred to Time Critical Transfers Under no circumstances are clinicians to delay the emergent transfer of an unstable patient in order to complete the Inter Hospital Transfer Request Form As a minimum, when transferring an unstable patient, the referring clinician should notify the relevant accepting Medical Officer, who should immediately inform the accepting Bed Manager In the event that a patient requires emergent transfer for treatment of an unstable illness, completion of the Inter Hospital Transfer Request Form should occur as soon as practicable after the patient has been stabilised and/or transported out of the facility If a time critical IHT patient requires Emergency Department intervention then the accepting Medical Officer should notify and obtain acceptance from the Emergency Department Consultant or delegate. 4. Supporting and related documents Authorising Health Service Directive Patient Access and Flow Health Service Directive Policy and Standard/s: Health and Hospitals Network Act (2011) Qld. Mental Health Act (2000) Qld. Effective From: 17 January 2014 Page 8 of 12

9 Queensland Health Authorised Transports Operating Standards (2009) Queensland Ambulance Service. Retrieval Services Queensland Activation Flowchart. Procedures, Guidelines, Protocols Guideline for Road Inter Hospital Transfer of Critically Ill Patients Queensland Ambulance Service Road Ambulance Ordering Guide Instructions for (QH) Staff. Forms and Templates Inter Hospital Transfer Request Form 5. Definition of Terms Term Definition / Explanation / Details Source Inter Hospital Transfer Transferred to another hospital: All separations for the period where the patient is transferred to another hospital for continuation of their admitted care and management Monthly Activity Collection Manual Public facilities. Inter Hospital Referral (non-admitted patients) Up transfer All separations for the period where the patient is transferred to another hospital for continuation of their care and management. Transfer or referral of a patient to another hospital for inpatient specialist treatment not available at the primary hospital Monthly Activity Collection Manual Public facilities. Queensland Counting Report 2011 Health Audit Effective From: 17 January 2014 Page 9 of 12

10 7. Approval and Implementation Guideline Custodian Michael Zanco Executive Director Clinical Access and Redesign Unit Health Services Innovation Branch Approving Officer: Approval date: DD/MM/YYYY Effective from: DD/MM/YYYY Effective From: 17 January 2014 Page 10 of 12

11 Appendix A: Inter Hospital Transfer Process Flowchart Effective From: 17 January 2014 Page 11 of 12

12 Appendix B: Inter Hospital Transfer Request Form Department of Health: Inter Hospital Transfer Guideline Effective From: 17 January 2014 Page 12 of 12