A retrospective descriptive analysis of critical care transfers in the private sector of South Africa

Master Thesis


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Background: Critical Care Transfers (CCTs) are necessitated by the growing prevalence of high acuity patients who require upgrade of care to multidisciplinary teams from less equipped referring facilities. Due to the high acuity of the critical care transfer patient, specialised teams with advanced training and equipment are called upon to undertake these transfers. The specialised and dedicated teams are utilized to mitigate and treat adverse events during transfers, which is found in the especially vulnerable, high acuity patients. Internationally, the insufficient data relating to CCTs has been repeatedly reported as a concern due to the increased number of critical care transfers being undertaken and the high acuity of the patients, along with the reported high number of adverse events that occur during such transfers. The inherent understanding of the potential effects, and therefore needs of the critical care transfer patient, are affected due to the paucity of international, but more specifically, local data relating to CCTs. Methods: This observational cohort study with a retrospective descriptive design samples all non-neonatal, critical care transfers completed for a one-year period (1 January 2017 – 31 December 2017) from the dedicated CCT of the two largest national emergency medical services in South Africa. Data were extracted from patient report forms by trained data extractors and subjected to descriptive analysis. Results: A total of 1839 patients were transferred between the two services (excluding the neonatal cohort). A total of 3143 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent primary diagnosis was Cardiovascular Disease (n=457, 25%), followed by infection (n=180, 10%) and Head Injury (n=133, 7%). Patients had an average of ~3 attachments, with the most prevalent being patient monitoring (n=2856, 155%). The second most prevalent attachment was Peripheral Intravenous Lines (n=794, 43%) of patients, followed by mechanical ventilation (n=496, 27%). A total of 2152 medications were required during transport, yielding an average of ~1 medication or infusion per patient transported. The most common medications recorded were CNS Depresants (n=588; 32%), followed by Analgesics (n=482, 26%), and a further 17% of patients required Inotropic / Vasoactive agents (n=320, 17%). Conclusion: This study provides insight into the demographics, most prevalent diagnoses and interfacility transfer monitoring needs of patients being transported in South Africa by two private dedicated critical care transport services. The results of this study should be used to inform future specialised critical care transport courses and qualifications, as well as the scopes of practice of providers undertaking critical care transfers.