>Ian Hepworth Wrote
>From an moral point of view should we be transferring moribund or
>terminally ill patients from ITU to ITU?
>I'd be pretty cheesed off if any relative of mine "died" during a TRANSFER.
>Fair enough dead on arrival or life extinct on scene but "we thought they
>might die but we needed to move them anyway"?

Hmmmm, whilst I agree with the sentiment the reality of ITU is somewhat
different.

1. Deaths may occur in transfer due to unexpected or sudden deterioration of
the patient. (an audit of PICU transfers showed that 30% had critical
incidents during them (1)).
2. We occasionally have to transfer VERY sick patients for specialist care.
For example for extracorporeal lung support in severe ARDS. Also paediatric
transfers (unless PICU transfer team available - they are not always).
3. For most of the past weekend we were on "red alert" as there were no (or
very few) ITU beds in the region. I transferred one patient 60 miles in
search of a bed and have transferred 5 patients in the past week (in the
three days I have been on call !!). One large Northern teaching hospital ITU
had more patients than nurses on Saturday.

It is particularly an issue here following a very widely publicised
paediatric death in transfer about 18 months ago.

I too would be very upset if anyone died in transfer (relative or not) but
unless we have more ITU beds (or use those that we have more effectively)
transfers and their attendant risks will continue. I hope this is not too
far off subject as A+E staff do occasionally transfer these patients rather
than anaesthetists/theatre staff up here.

For Christmas I will have to find a more pleasant subject. Any Christmas A+E
stories from anyone?
As a House Officer I was shown the x-ray of a young man who presented on New
years Eve with an extremely painful terminal phalanx of the right thumb.
X-rays showed a linear # of the terminal phalanx. he denied any trauma but
did claim to have played "sonic the hedgehog" virtually non-stop for the
last 7 days (having received a megadrive vfor Christmas). A diagnosis of
stress # was made. This was at the same time as all the concerns regarding
photoepilepsy were around. We really should have sent it Minerva (back page
of BMJ) I suppose.


Simon Carley
Anaesthetics / Intensive Care
Stepping Hill Hospital
Stockport
England
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1. Regional PICU audit by Royal Manchester Childrens Hospital about 2 years
ago. Following this money was made available for a specialist transfer team.



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