Deficits in Referral Notes During Inter-hospital Transfers of Critically Ill Patients: An Observational Study from a Developing Nation

Abstract

Aim: Currently there are no guidelines regarding the content of the clinical notes needed for transfer of patients from one centre to another. This problem is manifold in developing countries where intensive care is a developing specialty. This study was conducted to analyse the patient’s clinical information provided by the referral summary at the time of ICU admission. Settings: Twelve bedded intensive care unit (ICU) of a 900 bedded tertiary care referral centre. Observations: Over a period of 1 year, we had 310 intensive care admissions. One hundred and twenty-four patients out of these were out of hospital admissions. Ninty-six patients out of 124 patients had a prior hospitalisation of more than 24 hours. Patient information regarding the clinical details, source of referral, severity of illness, course in the previous hospital and management were analysed at time of admission. There were 62 (64%) male and 34 (36%) female patients. Mean admission APACHE-II (Acute physiological and chronic health evaluation) of referred patients was 15.89 ± 2.89 and mean SOFA (Sequential organ failure assessment) was 8.2083 ± 1.86. Authors found that majority of referral notes did not provide information regarding the presenting complaints, progression of signs and symptoms, progression of the organ failures, neurological assessment, airway and intubation details, ventilator settings on the blood gases, trends of vital parameters, nutrition, DVT prophylaxis and clinical status at time of discharge.