It is vital that critically ill or injured patients are treated rapidly in an acute hospital in order to treat and manage illness. However, there are several instances when such management may be followed by further (secondary) transfer to another acute hospital called inter-hospital transfers. These are either clinical transfers-when the facilities needed for definitive treatment are not available at the initial hospital or capacity transfer-when the initial hospital has inadequate equipment, bed capacity, staffing for continuity of care or repatriation-when highly specialised hospitals may need to transfer patients to ensure they can treat the next patient who needs their specialist facilities. Patients may also be moved back to hospitals nearer to their home and family. In these cases, patients will have had their specialist treatment, are almost always stable and the transfer may involve a step-down in the level of their care.

A significant proportion of critical care transfers are provided by Adult Critical Care Emergency Support Service (ACCESS) and remaining by London Ambulance Service NHS Trust . ACCESS is an NHS England, London commissioned critical care transfer and retrieval service hosted by Bart’s Health and delivered collaboratively by London Operational Delivery Networks in partnership with London Ambulance Service NHS Trust. ACCESS provides a dedicated and fully equipped mobile intensive care team for patient requiring inter-facility transfer whilst receiving on-going organ support.

ACCESS audits critical care transfers regularly. This helps inform quality of transfers service, promoting patient safety and patient experiences by sharing it with critical care network and other stakeholders.

Critically ill patients are sometime required to transfer within (Intra) a hospital for diagnostics, surgery or other reasons. This carries the same risk as transferring critically ill patients to another hospital (inter-facility). Staff undertaking these transfers have the necessary training and competence to assess, prepare, monitor and manage patients throughout transfers.

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