Transfer Advice

Policy or procedure

Being the only paediatric hospital in WA with tertiary care and intensive care facilities, PMH will often receive calls requesting transfer of critically ill children from all over the state. This poses special problems and requires unique skills and knowledge. Expert communication skills and development of rapport with the referring medical officer is key to successful management.

Expert advice is often required. Less experienced staff should exercise caution in providing advice for the management of critically ill children requiring inter hospital transfer. Depending on the case, specialist advice may be appropriate. This may require referral to the on call Emergency Department or Intensive Care Consultant. Occasionally, other sub specialties may need to be involved.

Initial advice may be given by the ED or PICU registrar with the offer to arrange specialist advice by return phone call. If there is any doubt or concern regarding the case, the registrar should seek consultant advice. Where there is a long delay between initial phone consultation and inter hospital transfer, a follow up call should be made to assess patient progress or provide further advice.

Accurate assessment and stabilisation prior to transfer is essential. PMH staff have a role in providing expert advice to achieve this.

In order to provide appropriate advice it is essential to appreciate a number of factors that will be encountered:

• Variable levels of skill and equipment at referring hospital
• Variable severity of illness or injury
• Urgency of transfer
• Anticipated course during transport
• Logistics of transfer e.g. mode of transport, use of specialised retrieval teams (RFDS, NETS)

It is important to appreciate the stresses the referring doctor is under, particularly if they have little experience in paediatric resuscitation and limited equipment and support staff. It is equally important to be aware the referring doctor may have more experience than the PMH doctor taking the initial call.

After making an assessment based on the history and information provided, give specific advice on:

• What to do (use ABCD approach)
• How to do it
• Recognition of potential complications/deterioration of the illness/injury
• Appropriate treatment of complications/deterioration
• Anticipation of the course of the disease pre transfer

Always obtain the name and contact number for the referring doctor and hospital. A Telephone Advice Record sheet should be used as a template for the referral call and completed as a record of the advice provided.

At Princess Margaret Hospital, calls from switchboard are initially put through to the Emergency Department (ED) phone. This is carried by an ED Consultant from the hours of 0800 until 2330. After hours, a Paediatric ED Registrar will answer the phone. We receive all calls for advice and requests for transfers of patients. We can then direct the call to Surgical or Medical Specialties as required for admissions, or to the Paediatric ICU if required.

Communication and paperwork

Telephone Advice Record