NICCaTS
The Northern Ireland Critical Care Transfer Service
Development of NICCaTS
A meeting of the Executive Committee of the Northern Ireland Intensive Care Group was held at Antrim Area Hospital on the evening of 14/8/00 to discuss the above. The meeting agreed on the points below.
- The service (to be known as the Northern Ireland Critical Care Transfer
Service - NICCaTS) will be provided primarily by anaesthetic SpRs providing
cover on a 1:4 non-resident rota.
- The service will transfer critically-ill adult patients, requiring
medical escort, from hospitals within NI to the most appropriate available ICU.
It is not a service to transfer less ill patients between hospitals
(i.e those not normally requiring medical escort and those not requiring an ICU
bed). In the event of two or more appropriate requests occurring
simultaneously, clinical urgency should be the first consideration.
With apparently similar cases, hospitals without anaesthetic trainees should
have priority over those with trainees.
- The service should NOT carry out transfers to other parts of the UK
e.g. for potential liver transplantation. Without further development,
it has the capacity to deal with only one patient at a time. The model will be
as follows; team and equipment taken by car to the referring hospital - team
and patient transported to ICU by ambulance. No nurse escort will be available
in phase I. It was stated that in the agreed business case, phase II
(including nurse escort) would commence within 12 months.
The meeting felt the lack of nurse escort (with the resultant need for the
referring hospital to supply a nurse for transfer) was regrettable and
constituted a lack of acceptable quality. There was agreement that the service
should commence as planned but that the case for nurses to be funded should be
pressed immediately.
- The service is to provide safe, high-quality inter-hospital transfers.
It is not a replacement for assessment and resuscitation at the referring
hospital by appropriately experienced staff.
- The meeting considered a number of further issues;
- Clinical responsibility
The patient would be the responsibility of the referring hospital staff while in
that hospital. Referring hospital staff would retain responsibility even after
the arrival of the transfer team and would be responsible for acts of commission
and omission. The transfer team is responsible for the patient during transfer
and passes this responsibility to the staff of the receiving hospital on arrival.
The team is responsible to the ICU consultant on duty at their base
- Regional Intensive Care Unit, RVH.
- Insurance
The transfer team must be adequately covered by insurance against death or
disability.
- ICU bed placement/bureau
The meeting felt it was desirable to separate the executive arm of IHT from
the body responsible for monitoring ICU bed vacancies and placement of patients.
It was agreed that such a body would be best placed in one of the
other "Golden Six" hospitals (Belfast City Hospital was specifically suggested)
and should be under the direct influence of medical and nursing staff.
It was agreed that patients with a requirement for "regional" services should be
accommodated in RICU,RVH. Cases without such a requirement should not normally
be transported into RICU unless no other suitable unit had an available ICU bed.
- Advisory Group
A group drawn from the transfer service personnel, NIICG (with adequate representation of the acute hospitals in NI) and NIAS should have an advisory, monitoring and audit role.
The meeting recognised the need for regional agreement on availability of ICU
beds, readiness to supply an accompanying nurse (in Phase I) and co-operation by
the NIAS and their funding health boards. CEOs/Medical Directors need to be
aware of the new service and its benefits and limitations. To facilitate all of
the above it was suggested that the Dept of Health should host a meeting of
relevant representative staff from across N. Ireland.
The service was potentially available in August 2000. However, due to some outstanding issues and delay in obtaining funding for equipment, a round-the-clock service will probably commence in early October 2000.
Initial decision
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