A patient in their 40s with a stroke underwent thrombolysis in the emergency department and  was referred to the local stroke unit. The transport requested by the ED consultant was unavailable and a plan was made to undertake transfer with an clinician from the hospital and the local ambulance service. The patient’s Glasgow coma scale (GCS) score was 8, and there was concern about the patient’s airway and potential deterioration en route. It was unclear who should escort the patient. Once it was decided this should be an anaesthetist further time was spent  deciding whether or not the patient needed to be intubated prior to transfer and finding the equipment and arranging for this to happen. Due to ongoing delays trying to organise transport, it was decided to undertake thrombectomy locally. However by the time the patient had been intubated the window of opportunity for thrombectomy had passed and was therefore not undertaken.

Commentary

There should be clear lines of communication between on-call anaesthetic and intensive care teams so it is clear who is responsible for transferring critically ill patients to other units. Departments should have clear local guidelines, including agreed time frames¹ Each hospital should have a lead consultant for critical care transfers with responsibility for staff training, competencies and equipment provision.² This is essential to avoid delays in time-critical care transfer such as occurred in this case.

1. Guidelines for the Provision of Emergency Anaesthesia Services, 2024. Royal College of Anaesthetists.
2. The Transfer of the Critically Ill Adult. Faculty of Intensive Care Medicine, The Intensive Care Society.    May 2019.