This document provides the framework to optimise safety of patients, staff and bystanders when transferring patients from the emergency department (ED) to the intensive care unit (ICU) or hospital wards, during the COVID-19 pandemic. It should be used to inform local policies and procedures, which should be current and reviewed regularly.
Transferring patients must be coordinated at a senior clinician level, with a clear agreement of which specialty team will be transporting the patient from the ED to the ICU or ward. A discussion between a senior ED
clinician and senior clinician from the receiving ward should take place to outline the safest and most appropriate mode to transfer (e.g. intubated,
non-invasive ventilation (NIV) via transport ventilator, non-rebreather mask (NRM), Hudson mask (HM) and nasal prongs (NP)).
Staff should communicate with the patient (if able) to discuss how the transport will proceed. This will prevent patient distress during the transfer.
Consideration must be taken to ensure safety of the patient, nursing and medical staff, transport staff and potential bystanders. A contingency plan should be made for medical emergencies during transport, which should be discussed with the team prior to the transport. Ensure that all equipment, infusion and equipment lines are secure.1-4
All staff involved in the transport, or in close contact with patients being transferred, must be fully vaccinated. They must also implement full airborne, droplet and contact personal protective equipment (PPE) (gloves, fluid- resistant gown, P2/N95 mask and eye protection) that have been fit-tested and fit-checked.3,5
Use a pre-planned, dedicated route. Patient transfers should use the shortest and safest route that minimises contact with the general hospital population, including clinicians (e.g. a dedicated lift service or external path). Map out and plan a 'routine' pathway for patient transfer between departments and one that will prevent collisions with other patient transports and transfers.
When using a lift to transfer a patient, only essential staff should be in the lift. If possible, place lift into 'independent service' mode to ensure the lift is not stopped and accessed by other users. Time spent in a lift must be with only essential staff, wearing full airborne, droplet and contact PPE.3,6
Utilise a 'clean' runner (this is a staff member that has not been in contact with a COVID-19 positive or suspected patient). They will ensure the pre-briefed route is clear of bystanders; will push elevator buttons and open doors; and clear the hallway of visitors, patients and clutter. Consider utilising security staff to assist in clearing the route of bystanders before the transport.4
ACI Intensive Care NSW with consultation of senior clinicians from intensive care and emergency departments
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
This document is for any COVID-19 positive patient that requires intrahospital transfer.
To assist clinicians with intrahospital transfer of COVID-19 positive patients.