Skill List > Patient Transfers: To Other Facilities/Units or Hospitals
Clinical Alert
Determine whether the patient’s condition and safety require life support equipment. Staff assisting with transfer require up-to-date training in life support measures. When the patient is being transported to a new institution, a vehicle equipped with life support equipment is necessary. Priority assessment includes the patient’s ability to maintain their airway, vital signs, level of consciousness and patency of intravenous cannulae, lines, and that the correct fluid is being infused at the prescribed rate.

Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation.
Authors:
Based on Mosby Nursing Skills
Adapted by: Chris Brooker BSc MSc SRN SCM RNT
Updated by: Chris Brooker BSc, MSc, SRN, SCM, RNT
Last updated: March 2018

Learning Objective
After reading the skill overview, watching the video, following up some of the references/web sites and completing the self-test quiz you should be ready to be assessed in practice in the skill of transferring patients to other facilities/units or hospitals.

Introduction

Patients transfer to new wards or units and different care settings in order to receive advanced specialist care, appropriate treatment and care, or to be closer to home. During the patient transfer, it is important to ensure continuity of nursing care. The aim is to continue health care and avoid treatment interruptions that might hinder progress towards recovery. Open collaboration with all agencies/health professionals involved and effective communication help ensure quality patient care and safety throughout the transfer.

When a patient is being transferred from one unit or ward within the same hospital, it is usually easy to complete the process without interrupting care activities. Policies and procedures are usually similar throughout the hospital; however, this needs to be checked prior to the transfer. The nurse first provides a telephone report to the receiving nurse. This allows the receiving nurse to prepare for the patient (e.g., preparing the bed area or room and securing necessary equipment). As clinically appropriate, the nurse may accompany the patient during transport, providing the receiving nurse with the patient’s medical record, introducing the patient to the receiving nurse, and providing an updated report, including any changes in clinical condition or plan of care.

In the emergency department (ED), when a patient is transferred from one hospital to another, the nurse completes the transfer in compliance with local policy. The senior nurse or doctor will liaise with the ambulance service, other types of transport, and the patient’s next of kin. An appropriate transfer includes:

  • Explaining to the patient and next of kin the need for the transfer.
  • Obtaining the patient’s or next of kin’s informed consent for transfer.
  • Ascertaining that a bed is available in the appropriate unit, and that the receiving hospital confirms this and is expecting the patient.
  • Collecting the patient’s property, and recording all property in the property book according to local policy. Next of kin may wish to take some property home, after checking the property book and signing a receipt. Provide suitable bags.
  • Making copies of all relevant medical records, including a transfer form, sent by the transferring hospital to the hospital receiving the patient.
  • Transporting the patient using qualified personnel and transportation equipment (e.g., ambulance with advanced life support (ALS) and other specialist equipment)

Transfers frequently create anxiety for the patient and next of kin. Carefully repeat instructions regarding transfer at a time when the patient and family are better able to concentrate and understand the explanation. In this situation, always ask the patient (or next of kin) to repeat any critical information and whether they have any questions.

Cultural considerations

  • When transferring patients who are from diverse cultures and religions, it is important to understand their cultural and religious practices.
  • Assess the use of complementary and alternative medicine to determine the impact the use of these have on a patient’s decisions related to medical care (Giger 2016).
  • A patient’s cultural practices include family decision making. For example, in some cultures the adult male leader is the decision maker. Develop trust by working with the established family and social hierarchy, recognising those in authority, and with the patient’s permission, involving them in decision making in the patient’s care.
  • For patients who are Orthodox Jews, plan transfers so the patients can begin observance of the Sabbath (sundown on Friday to sundown on Saturday) undisturbed. Orthodox Jews follow the beliefs of their religion closely (Giger 2016).
    Be aware of a cultural group’s beliefs in regard to eye contact and touch. For example, eye contact is considered disrespectful and rude by Chinese people. Limit eye contact with members of these groups while you are taking a history or performing an assessment. Some groups, such as Orthodox Jews, find excessive touching offensive. Limit the amount of touching during the transfer process (Giger 2016).

Transferring children

  • Children need their parents’ comfort and security; for this reason, make sure parents are well informed of all arrangements. Involve older children in any discussion regarding transfers. Arrange for a parent to accompany their child in the transfer.

Transferring older people

  • Relocation of an older adult patient to a new ward or unit, hospital, or other care setting can be stressful. Ensure that significant support persons are still accessible and that the patient is thoroughly oriented to their new surroundings. Also make sure that the patient is able to take important possessions and memorabilia and is fully involved in making decisions about their care.

Preparation and safety

  • Obtain transfer documentation, including the name of the receiving hospital (when applicable), the receiving doctor’s name, and information regarding the patient’s stability for transfer. ‘The main aim in all such transfers is maintaining the continuity of medical care’ (Kulshrestha & Singh 2016).
  • In collaboration with the doctor and relevant health and social care professionals, assess the reason for the patient’s transfer (e.g., change in condition, services available at the new location, patient or family preferences regarding the patient’s location).
  • Explain the purpose of the transfer thoroughly and provide time to discuss the patient’s and family’s feelings about the change in care setting. As necessary, obtain the patient’s informed consent to transfer. If the patient is unable to consent, their family provides informed consent.
  • Assess the patient’s current physical condition and determine the method of transport. When transferring a patient to a new health or care setting, assess the method of transport to the transferring vehicle (e.g., wheelchair, trolley).
  • Assess if the patient requires pain relief or other medicines for symptom management. Routine medicine administration should be up to date.
  • Ensure that staff have notified the patient’s family or significant others of the transfer, as desired by the patient.
  • Arrange for appropriate transport to take the patient to the new hospital or other care setting.
  • When a transfer is being made to another hospital or care setting, contact the relevant person to confirm acceptance of the patient and that a bed is available (the social worker or discharge coordinator may complete this task). The nurse will need to complete discharge documentation and telephone the accepting hospital to provide a verbal report.

Procedure

  1. Explain the reason for the transfer with the patient, if appropriate. The next-of-kin must be informed of the transfer.
  2. Make sure documentation in the patient’s record is complete. Individualise nursing care measures based on patient need.
  3. Complete the nursing care transfer form. The medical notes accompany the patient to a new ward or unit or new hospital.
    Rationale – The form provides a summary of the patient’s pertinent nursing care needs to ensure continuity of care and prevents unnecessary duplication of services. Medical notes are required for full information so all concerned are aware of the patient’s history, illnesses, treatment, allergies, special dietary requirements, and wishes regarding treatment (e.g. advance decisions, advance statements).
  4. Check the patient’s medications. Check the patient’s current medicines against the most recent prescription and the original home medication list. Communicate the current medication list to the new ward or unit, hospital, or care setting. Check whether the patient has their own medicines.
    Rationale – Ensures that the patient receives the correct medicines at the new care setting and reduces the possibility of drug errors.
  5. Collect all patient-specific medications on the unit and transfer with the patient.
    Rationale – If certain medications are not sent with the patient, there may be a delay in obtaining and administering them in the new ward, unit, or hospital.
  6. Collect the patient’s personal care items, clothing, and valuables. Two nurses complete and sign the property book as per local policy. Check the entire bed area or room and all storage areas. Secure items in a suitcase, bags, or container.
  7. Anticipate problems the patient may experience before or during transfer. Ask the patient if they need to visit the lavatory or use a commode, bedpan, or urinal. Perform necessary nursing care such as oral care, suctioning, or dressing change. 
    Rationale – Ensures the patient’s comfort and safety during transport.
  8. Empty all drains and catheter bags and document the final total intake and output.
    Rationale – Prevents unnecessary exposure of the transfer personnel and patient to body fluids if drains or collection bags leak during transport.
  9. Assist in transferring the patient to a trolley or wheelchair, using safe patient handling techniques. Provide appropriate pressure redistributing (relieving) equipment. 
    Rationale – It is easier to move the patient being transported to an outside institution by trolley into the transport vehicle. Protect pressure areas during transport to the new ward, unit, or hospital.
  10. Perform and document a final assessment of the patient’s physical stability.
    Rationale – Minimises the risk of deterioration or complications during transfer.
  11. When the transfer occurs to another hospital or care setting, accompany the patient to the transport vehicle. 
    Rationale – Ensures that qualified personnel are in attendance until the patient leaves the hospital.
  12. Contact the new hospital or care setting and notify the staff there of the impending transfer and the patient’s condition.
    Rationale – Notification of the nurse in charge or nurse assuming care of the patient ensures better continuity of care at the time of the patient’s arrival.
  13. Document the transfer in the patient’s record and inform the patient’s family.

Ongoing care, monitoring and support

  • During the final assessment, compare data with the previous findings.
  • Inspect the patient’s alignment and positioning on the trolley or wheelchair.
    Rationale – Proper alignment and positioning reduces the risk of an injury during transport.
  • Confirm that the patient understands the transfer and procedures through discussion and questions.
  • Determine whether the receiving institution or nurse has questions about the patient’s care.
  • Notify the family of the patient’s transfer (if requested by the patient or family).
    Rationale – Transfers may be delayed for numerous reasons. Letting the family know when the transfer is actually occurring can reduce any anxiety of the patient and/or family related to the transfer.

Documentation and reporting

  • All relevant information conveyed to the patient and next of kin and their questions are answered.
  • Nurse transferring patient:
    • patient’s condition, including vital signs and other assessment findings
    • nursing plan of care
    • date and time of transfer
    • method of transport.
  • Nurse receiving patient:
    • date and time of arrival
    • reason for transfer
    • method of transport
    • patient’s condition
    • care provided at time of arrival.
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