Updated guidelines for safe transfer of patients with a brain injury
Guidelines published today (2 December 2019) in the journal Anaesthesia, produced by the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society, provide practical guidance for ensuring the safe transfer between hospitals of patients with a brain injury. The transfer of patients is potentially hazardous if poorly executed and these updated guidelines are for those responsible for planning, managing and undertaking transfer of brain-injured patients. The aim is to ensure a safe transfer of patients and also to assist in local discussions when establishing new or improving existing transfer arrangements.
The location of care for many brain-injured patients has changed following the development of major trauma centres and advances in management of ischaemic stroke have led to the urgent transfer of many more patients. Patients with an isolated head injury, major trauma, and those who deteriorate while in hospital may require transfer between hospitals. In some regions, critical care networks and transfer groups have been established, but elsewhere patients with a brain injury will require staff within a local unit to arrange and undertake a transfer.
The guidelines provide 11 recommendations, covering key areas including:
Organisational aspects - The safe transfer of patients with brain injuries requires an effective partnership between the referring teams, the regional neurosciences or stroke unit, and the local ambulance service. Every hospital that receives patients with serious brain injuries should have facilities for resuscitation and diagnosis, including 24 h access to CT imaging. Appropriate staff and equipment should be available at all times to ensure a safe transfer to the neuroscience unit when necessary.
Preparation for transfer - The decision to transfer a patient with a brain injury shouldbe made by senior medical staff at the referring hospital in consultation with senior staff at the neurosciences unit. Appropriate resuscitation and stabilisation of the patient before transfer is the key to avoiding complications during the journey. When a request is made for an ambulance to transfer the patient (including those with acute ischaemic stroke), the dispatcher should be told the patient has a life-threatening emergency.
Care during the transfer - During transfer, patient management will be centred on maintaining oxygenation and adequate blood pressure, and minimising rises in ICP. As far as possible, a smooth journey (without marked acceleration and deceleration) will have less impact on a patient with an injured brain. A patient who is physiologically stable before departure is more likely to remain so for the duration of the transfer, although there is still the need for constant vigilance and prompt action to deal with complications.
Paediatric transfers – Paediatric transfers are high-risk and there should be a pre-determined pathway for referral and transfer of brain-injured children developed in agreement by the regional transport service, regional trauma network and the regional neuroscience network.
Dr Mike Nathanson, President-Elect of the Association of Anaesthetists and Chair of the guidelines working party, said: “We believe that high-quality transfer of patients with a brain injury is associated with a better outcome. These guidelines encourage departments to review their own practices and suggest training and organisational improvements to ensure safe transfer with the aim of avoiding harm to patients. Most principles of safe transfer are common to all seriously ill patients, but these guidelines highlight specific risks that apply to those with an acute brain injury.”
Roger Lightfoot, President of the Neuroanaesthesia and Critical Care Society, said: “The collaboration of the Neuroanaesthesia and Critical Care Society with the Association of Anaesthetists has allowed this version of the guidelines to be relevant and set the correct standards to ever developing area of patients with acute brain injury. The important inclusion of organisational aspects as well as clinical guidelines will allow local departments to undertake a comprehensive review of their own practice and therefore improve care. It has been an honour to work with the Association and going forwards we hope to build on this partnership.”
A webinar about these guidelines will take place on Monday 9 December 2019. Full details of the webinar can be found here.
Notes for editors:
For media enquiries, embargoed copies of the guidelines and interview opportunities please contact:
Amelia Lyons, press officer, Association of Anaesthetists, on: 07989 748 477 or email: [email protected].
Guidelines for safe transfer of the brain-injured patient: trauma and stroke is published in the journal Anaesthesia on 2 December 2019, available at: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14866
Authors of the report are:
M. H. Nathanson,1 J. Andrzejowski,2 J. Dinsmore,3 C.A. Eynon,4 K. Ferguson,5 T. Hooper,6
A. Kashyap,7 J. Kendall,8 V. McCormack,9 S. Shinde,10 A. Smith11 and E. Thomas12 1
1 Consultant, Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK; Immediate Past Honorary Secretary, Association of Anaesthetists (Working Party Chair)
2 Consultant, Department of Anaesthesia, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK; Past President, Neuro Anaesthesia and Critical Care Society (NACCS)
3 Consultant, Department of Anaesthesia, St George’s University Hospital NHS Trust, London, UK; Royal College of Anaesthetists
4 Consultant Department of Intensive Care, University Hospitals Southampton NHS Foundation Trust, Southampton, UK; Intensive Care Societies of England, Ireland, Scotland and Wales
5 Consultant, Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen; President, Association of Anaesthetists
6 Consultant, Department of Intensive Care and Anaesthesia, North Bristol NHS Trust, Bristol, UK; Defence Medical Services
7 Consultant, Department of Paediatric Intensive Care, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Paediatric Intensive Care Society
8 Consultant, Department of Emergency Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; Royal College of Emergency Medicine
9 Specialist Trainee, Anaesthesia and Intensive Care Medicine, North West Deanery; Previously Vice-Chair, Association of Anaesthetists Trainee Committee
10 Consultant, Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; Vice President, Association of Anaesthetists
11 Consultant, Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK; Editor, Anaesthesia 12 Consultant, Department of Intensive Care Medicine, Plymouth, UK; Honorary Secretary, NACCS
About the journal Anaesthesia
Anaesthesia is the official journal of the Association of Anaesthetists of Great Britain and Ireland and is international in scope and comprehensive in coverage. It publishes original, peer-reviewed articles on all aspects of general and regional anaesthesia, intensive care and pain therapy. Its Impact Factor for 2018 is 5.4 and it is 3rd out of 31 (Anaesthesiology) in the ISI Journal Citation Reports© Ranking.
About the Association of Anaesthetists
As the professional membership organisation for over 11,000 anaesthetists in the UK, Republic of Ireland and internationally, the Association of Anaesthetists promotes patient care and safety, and advances anaesthesia through education, publications, research and international work. The Association maintains an active programme of support for anaesthesia worldwide, especially in low- and middle-income countries. Its motto in somno securitas (‘Safe in Sleep’) encapsulates the major focus of the Association: safety in anaesthesia. www.anaesthetists.org
About the Neuro Anaesthesia and Critical Care Society
The Neurocritical Care Society is one of the oldest Specialist Societies established in 1965 from the Neuroanaesthesia Travelling Club. It has in excess of 370 members from all areas of the MDT who have an interest in Neuroanaesthesia and Neurocritical Care. Its key objectives include the advancement of knowledge and education and promotion of standards of care for the benefit of the public.
Along with organising its own scientific meetings and events the Society has been active in developing strong partnerships with other Societies and Associations throughout the world including the Society of Neuroanaesthesia and Critical Care (North America),the Indian Society of Neuroanaesthesia and Critical Care and the World Federation of Society of Anaesthesiologists. www.naccs.org.uk Twitter: @naccsuk