Towards the safer transfer of children during winter bed crises: a survey of London paediatric registrars' opinions on current transfer arrangements in order to improve patient safety

Abstract

Aims During the busy winter season, large numbers of children are being transferred between hospitals in London due to bed shortages. This paper aims to research current practices, find out what information is considered to be essential in handover, whether children have been received in an unstable condition and if paediatric registrars would find a universal transfer protocol useful in reducing workload and improving patient safety. Methods Paediatric registrars of all grades were contacted by email and at London deanery training days and asked to complete a questionnaire on their views about current transfer procedures. Results 103 registrars from 27 hospitals in the London Deanery returned the questionnaire. Only 4.8% reported that their hospital had a transfer protocol. 89% said they were responsible for arranging the transfer of the child and that they spent an average of 2 hours per transfer. Alarmingly, 43.6% responded that they had accepted a child that had arrived in an unstable condition. In 8 (17.7%) of these cases, the child being transferred had breathing difficulties (six with asthma, two with croup). Insufficient access was another common theme including two children that needed intraosseus access on arrival. Two children required fluid boluses on arrival. One registrar described a child with sepsis and undiagnosed sickle cell disease who died shortly after arrival. Information expected in telephone handover and transfer letter is shown in the graph below (numbers in percentages of registrars who felt the information was essential) (figure 1): 94 registrars (91.2%) felt that a single universal protocol would be helpful in the management and transfer of patients in winter bed crises. Conclusions It is clear from the results that improvements need to be made to patient safety during transfers in winter bed crises. It appears that the most vulnerable patients to deterioration during transfer are those with respiratory difficulties, consequently particular care should be taken to stabilise these patients prior to transfer. As the majority of registrars felt that a universal protocol would be helpful to improve safety and ease of transfer, the researchers are now trialling new transfer paperwork.