ACCP OSF: Inter-Hospital Transfer

Since their introduction, the role of Advanced Critical Care Practitioners (ACCPs) has developed over time. Whilst transfer of the critically ill patient within hospital (intra-hospital transfer) is part of core ACCP training, solo transfer between hospitals (inter-hospital transfer) is less commonly undertaken by ACCPs as part of their job role in individual units therefore experience and supervised practice within this area may be limited.

Reasons for inter-hospital transfer

The inter-hospital transfer of critically ill and injured patients occurs for three reasons:

1. Escalation of care (where patients need to access specialist treatment not available in the referring hospital)
2. Repatriation (the transfer of patients back to their local hospital when they have completed specialist care or become unwell distant to home)
3. Capacity (where patients require transfer owing to a lack of space, staffing, equipment, etc.)

For the past two decades, commissioned, dedicated neonatal and paediatric critical care transfer services have developed and become integral to the delivery of care to these patients across the country. In adults, the provision has been less organised. Prior to the COVID-19 pandemic, dedicated services were operational, or in development, in the devolved nations of Northern Ireland, Scotland and Wales, but no provision had been made in England outside of ECMO retrieval services.

The COVID-19 pandemic served as the catalyst for the rapid establishment of Adult Critical Care Transfer services (ACCTS) in England, and the subsequent publication of the NHS England Service Specification for ACCTS in June 2021 (updated May 2022). ACCTS in England are in the relatively early stages of development in comparison to the devolved nations but as all ACCTS across the UK evolve, there is opportunity for ACCPs to work within them in a similar way to paediatric and neonatal Advanced Practitioners (APs) within their respective services. As these services and opportunities evolve in the future, it will be necessary to review and amend this OSF.

Training established ACCPs in inter-hospital transfer, in addition to completing the Advanced Airway Management OSF, will allow ACCPs to undertake inter-hospital transfer working for an Adult Critical Care Transfer services, as these opportunities arise. It will also facilitate robust training and governance arrangements for ACCPs to undertake inter-hospital transfers as part of their role working within critical care units.

Eligibility

The ACCP is expected to have already achieved, signed off, and registered with the Faculty the Advanced Airway OSF prior to commencing part two of the Inter-hospital Transfer OSF.

Aims

Assess patient suitability for inter-hospital transfer by an ACCP

• Prepare patient and equipment for safe inter-hospital transfer
• Manage the process of inter-hospital transfer and any anticipated or unexpected complications
• Liaise effectively with referring and receiving units
• Communicate effectively and demonstrate leadership around the process of inter-hospital transfer

Development

This module and associated competencies have been developed for the training of ACCP’s who have completed core training and hold FICM Membership as an ACCP.

Inter-hospital transfer should be seen as an optional additional skill for ACCPs who wish to develop their practice and where there is a clearly identified local service need. These competencies are based on the FICM ICM Curriculum Special Skills Year Handbook, August 2021. At present this is not part of the requirements for FICM core ACCP training