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Patient Referral and Transport

STABILIZATION AND TRANSFER

  • Resuscitation completed
  • Analgesia administered
  • Laboratory specimen sent
  • Fractures immobilized
  • Documentation completed
  • Transfer
    • Ward
    • Operating theatre
    • Higher level of care centre

DECISION MAKING

Can we do procedure here?

  • Is operating theatre safe, ready to use?
  • Are necessary equipment, drugs, supplies available?
  • Are team members available?
  • Do I have knowledge and skill to perform necessary procedure safely?
  • Is there back-up or extra support available if needed?
  • Can we manage potential complications if problems arise?
  • Do we have facilities for good post-operative care?

If the answer to any of these questions is "NO" it is inadvisable to proceed with surgery!

TRANSFER OF TRAUMA PATIENT

Patient transfer carries inherent risk

Patients must be stabilized prior to departure:

  • Effectively resuscitated
  • Controlled airway
  • Normalized circulation
  • Immobilized fractures
  • Appropriate analgesia
  • Functioning intravenous lines

Patients should be transported only to facilities offering higher level of care

Planning and preparation:

  • Mode of transport
  • Accompanying personnel, including family
  • Supplies needed for any possible treatment
  • Identifying possible complications
  • Communicate with all involved in transfer including receiving hospital

Be prepared: if anything can go wrong, it will and at the worst possible time!

PATIENT SAFETY: Consent

Informed consent means that patient and patient’s family understand

  • What is to take place
  • Potential risks, complications of both proceeding and not proceeding
  • Have given permission for intervention

Be attentive to legal, religious, cultural, linguistic, family norms and differences

Our job is not to judge, but to provide care to all without regard to social status or any other considerations

With invasive, surgical procedures important to fully explain :

  • What are you proposing to do?
  • What are reasons for recommending procedure?
  • What are expectations, goals?

Communicate effectively:

  • Use language that can be understood
  • Draw pictures, use an interpreter if necessary
  • Allow patient, family members, elders to ask questions and consider what has been discussed
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