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On successfully completing this topic, you will be able to:
appreciate an overview of the principles of the safe transfer or retrieval of critically ill patients
understand the systematic ‘ACCEPT’ approach for managing such patients.
Introduction
The aim of a safe transfer policy is to ensure that maternal and neonatal care is streamlined and of the best standard. Transfer may be necessary for maternal or fetal reasons (specialised neonatal care, or the availability of neonatal unit cots). Maternal transfer may be for an obstetric problem such as pre-eclampsia, or for a problem not directly related to the pregnancy.
To achieve successful transfer or retrieval, the right patient has to be taken at the right time, by the right people, to the right place by the right form of transport and receive the right care throughout. The added complexity in obstetrics of dealing with ‘two patients’ demands a highly systematic approach, that incorporates a high level of planning and preparation, prior to the patient being moved. One such approach is the ACCEPT method developed by the ALSG.
The ACCEPT systematic approach to patient transfer
- A
Assessment
- C
Control
- C
Communication
- E
Evaluation
- P
Preparation and packaging
- T
Transportation
Following ACCEPT ensures that assessments and procedures are carried out in the right order. This method also correctly emphasises the preparation that is required before the patient is transported. The component parts of ACCEPT are outlined below.
Assessment
The clinician involved in the transportation may have been involved in the care given up to that point. However, the transporter may have been brought in especially for that purpose and will have no prior knowledge of the patient’s clinical history. It is the responsibility of the person undertaking the transfer to become fully appraised.
Control
Once assessment is complete, the transport organiser needs to take control of the situation. This requires the following:
identifying the clinical team leader
identifying the tasks to be carried out
allocating tasks to individuals or teams.
The lines of responsibility must be established urgently. In theory, ultimate responsibility is held jointly by the referring consultant clinician, the receiving consultant clinician and the transfer personnel at different stages of the transfer process. There should always be a named person with overall responsibility for organising the transfer.
Communication
Moving ill patients from one place to another requires cooperation and the involvement of several people. Therefore, key personnel need to be informed when transportation is being considered.
People who need to know about a transfer
The neonatologists in referring and receiving units should communicate directly. Who to involve in maternal care depends on whether the mother is being transferred for an obstetric problem or a nonobstetric problem. If the transfer is for a nonobstetric problem, obstetric care also has to be continued in the receiving unit and has to be transferred to an obstetric team at the receiving unit. Consider informing the following people, as appropriate:
the consultant responsible for current maternal clinical care
the consultant responsible for current obstetric care if different from above
the consultant responsible for current neonatal clinical care
special care unit staff in transferring hospital
the consultant responsible for the transfer of the patient (if different from above)
the consultant responsible for maternal intensive care if appropriate
the senior midwife in transferring unit
the patient’s relatives
the consultant responsible for maternal clinical care in the receiving unit
the consultant responsible for obstetric care in the receiving unit
the consultant responsible for neonatal care in the receiving unit
special care unit staff in the receiving unit
the senior midwife in the receiving unit
ambulance control or special transportation controls (when appropriate).
If anaesthetists have been involved in the obstetric care, they should communicate directly.
Communication may take a long time to complete if one person does it all. It is therefore advisable to share the tasks between corresponding teams, taking into account expertise and the local policies. Team-to-team communication is imperative. In all cases it is important that information is passed on clearly and unambiguously. This is particularly the case when talking to people over the telephone. It is useful to plan what to say before telephoning and to use the systematic summary shown below.
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