Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients.
OBJECTIVE
The inter-hospital transfer of critically ill patients in the United Kingdom is commonly undertaken using standard ambulance under junior doctor escort, despite recommendations for the use of specialist retrieval teams. Patients are transferred into University College London Hospitals (UCLH) intensive care unit (ICU) by both methods. We undertook to evaluate the effect of transfer method on acute physiology (within 2 h of ICU admission) and early mortality ( < 12 h after ICU admission).


METHODS
Retrospective review of all transfers over 1 year.


METHODS
UCLH ICU.


METHODS
259 transfers; 168 by specialist retrieval team (group A) and 91 by standard ambulance with doctor provided by referring hospital (group B).


METHODS
None.


METHODS
Acute physiology (pH, PaO2, PaCO2, heart rate (HR), mean arterial blood pressure (MAP), 24 h severity of illness scores (APACHE II, SAPS II), length of stay and mortality.


RESULTS
There were no differences in demographic characteristics or severity of illness between the two groups; nevertheless significantly more patients in group B than in group A were severely acidotic (pH < 7.1: 11% vs. 3%, p < 0.008) and hypotensive (MAP < 60: 18 % vs. 9%, p < 0.03) upon arrival. In addition, there were more deaths within the first 12 h after admission with 7.7 % deaths (7/91) in group B transfers vs. 3% (5/168) in group A.


CONCLUSIONS
The use of a specialist transfer team may significantly improve the acute physiology of critically ill patients and may reduce early mortality in ICU.
Bellingan
G
G
Bloomsbury Institute of Intensive Care Medicine, Rayne Institute, London, UK.
Olivier
T
T
Batson
S
S
Webb
A
A
D000552:Ambulances; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008131:London; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010360:Patient Transfer; D012189:Retrospective Studies; D015996:Survival Rate; D006113:United Kingdom