Interfacility Transfer Toolbox

To ensure the best possible outcomes, critically ill and injured children must be treated at facilities most prepared to address their needs. Hospitals should have Interfacility Transfer Agreements (written formalized arrangements between healthcare facilities) that specify alternate care sites capable of meeting the clinical needs of critically ill and injured pediatric patients and appropriate guidelines that outline procedural and administrative policies for transferring pediatric patients to facilities that provide specialized pediatric care.

HEALTHCARE PROVIDER RESOURCES

American Academy of Pediatrics

• Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients, currently in its third edition, is geared for healthcare professionals who make decisions about pediatric emergency interfacility transport and includes a sample Interfacility Transfer Agreement. (2006)

• The State of Pediatric Interfacility Transport: Consensus of the Second National Pediatric and Neonatal Interfacility Transport Medicine Leadership Conference, sponsored by the American Academy of Pediatrics in 2000, represents the ideas and thoughts of transport leaders. (Accessed October 2008)

• The Academy’s website includes the following policy statements related to interfacility transfer agreements: Access to Pediatric Emergency Medical Care, which promotes interfacility transfer agreements to ensure timely access to pediatric emergency medical care (2000); Pediatric Care Recommendations for Freestanding Urgent Care Facilities, which recommends that urgent care facilities have prearranged transfer and transport agreements (2005); and Facilities and Equipment for the Care of Pediatric Patients in a Community Hospital, which includes guidance to community hospitals on referral networks and transfer of pediatric patients (2003).

• The Academy’s Section on Transportation Medicine provides information to health care professionals responsible for pediatric interfacility transport in efforts to improve the care of children who require interfacility transport.(Accessed October 2008)

American College of Critical Care Medicine

• Guidelines for the Inter- and Intrahospital Transport of Critically Ill Patients Critical Care Medicine, promote measures to ensure safe patient transport.(2004)

American College of Emergency Physicians

• Interfacility Transportation of the Critical Care Patient and Its Medical Direction concerns training and support for critical care transportation agency physician medical directors to ensure that critically ill or injured patients receive the best care possible. (2005)

American College of Surgeons

• Consultation for Trauma Systems is a tool for those charged with evaluating trauma systems and includes a section on interfacility transfer. (Accessed October 2008)

• Interfacility Transfer of Injured Patients: Guidelines for Rural Communities is a resource for health care professionals that includes transfer protocols and interhospital triage criteria. (2002)

Commission on Accreditation of Medical Transport Systems

• This multi-member commission is focused on improving the quality of patient care and safety of the transport environment for services providing rotor wing, fixed wing, and ground transport systems. The Commission’s membership includes the following organizations: Aerospace Medical Association, Air Medical Physicians Association, American Academy of Pediatrics, American Association of Critical Care Nurses, American Association for Respiratory Care, American College of Emergency Physicians, Association of Air Medical Services Emergency Nurses Association, National Air Transportation Association, National Association of Air Medical Communications Specialists, National Association of EMS Physicians, National Association of Neonatal Nurses, National Association of State EMS Officials, National EMS Pilots Association, Air and Surface Transport Nurses Association, and International Association of Flight Paramedics. (Accessed October 2008)

EMSC National Resource Center

• Introduction to Interfacility Transfer Agreements and Guidelines. This February 2008 Maternal and Child Health Bureau webcast describes the need for interfacility transfer, reviews federal performance measures #66d and #66e, identifies components of interfacility transfer guidelines, and discusses implications of transfer guidelines to clinical outcomes for children. (Accessed November 2008)

• EMSC State Partnership Performance Measures. Federal grantees are required to report on specific performance measures related to their grant funded activities. The measures are part of the Government Performance Results Act (GPRA) and directly address operational capacity to provide pediatric emergency care, including development and adoption of Interfacility Transfer Agreements. (Accessed October 2008)

Emergency Nurses Association

• The Association developed several position statements concerning interfacility transfer issues, including: Care for the Pediatric Patient during Interfacility Transfer (2001) and Care of the Critically ill or Injured Patient During Interfacility Transfer. (2005)

National Association of EMS Physicians

• The Association's position paper Medical Direction of Interfacility Transports is designed to serve as a tool to encourage optimal transport of patients between health care facilities. (2000)

National Highway Traffic Safety Administration

• National Highway Traffic Safety Administration Guide for Interfacility Patient Transfer, developed through the U.S. Department of Transportation, National Highway Traffic Safety Administration’s Office of EMS, is designed to provide resources to assess and support development of interfacility transfer.(2006)

The Joint Commission

• The Joint Commission offers guidance on medical transport issues through the Commission’s JCI Accreditation Standards for Medical Transport Organizations. (Accessed October 2008)

Air & Surface Transportation Nurses Association

• Staffing of Critical Care Air Medical Transport Services, was developed in collaboration with the Emergency Nurses Association. (2001)

• Standards for Fixed Wing, Standards for Rotor Wing, and Standards for Ground Transport is a three-volumn resource on guidance for medical transport vehicles. (Accessed October 2008)

Commission for Accreditation of Ambulance Services

• Through the support of its Board of Directors, the Commission’s standards for the medical transportation industry were revised in 2004. (Accessed October 2008)

State Resources

• Model Pediatric Interfacility Transfer Agreement, EMS Authority, CA. (Accessed October 2008)
• Interfacility Pediatric Trauma and Critical Care Consultation And/Or Transfer Guidelines, Department of Health, IL. (Accessed October 2008)
• Interfacility Transport Guidelines, Bureau of Local Health Support and EMS, WI. (Accessed October 2008)

Local Resources

• Hospital Guidelines for Interfacility Transfers Via Ambulance, Contra Costa Health Services, CA. (Accessed October 2008)

IN THE SPOTLIGHT: AN INTERVIEW WITH DR. BRUCE KLEIN

“It is important for those concerned about children’s health care to support the development of interfacility transfer agreements between their community hospitals and pediatric tertiary care facilities,” Dr. Klein said. “These agreements get hospitals thinking about how they will manage patients needing transport to a higher level of care facility in advance of such a situation, rather than forcing providers to cope with these issues during such an incident.”

“It only makes sense that transfer will be more expeditious if providers at the community hospital level know in advance where and how a critically ill or injured child will be transported.” Dr. Klein continues that, “if these agreements are in place prior to an emergency event, recommendations regarding care could be provided earlier and the patient transferred to a tertiary care center sooner, perhaps increasing the chances of a better outcome for the critically ill or injured child.”

For more information about interfacility transfer agreements, feel free to contact Dr. Klein at:

Bruce Klein, MD, FAAP
Chief
Division of Transport Medicine
Children’s National Medical Center
111 Michigan Avenue, NW
Washington, DC 20010
202-476-4177
202-476-3573 (fax)
bklein@cnmc.org

Other Leaders in Interfacility Transfer

Monica Kleinman, MD, FAAP
Medical Director
Transport Program
Children’s Hospital Boston
Division of Critical Care Medicine
300 Longwood Ave, MICU Office-Farley 517
Boston, MA 02115-5737
617-355-7327
617-355-3863 (fax)
monica.kleinman@childrens.harvard.edu

Richard Orr, MD, FAAP
Director
Pediatric Critical Care Transport
Department of Critical Care Medicine
Children’s Hospital of Pittsburgh
University of Pittsburgh
3550 Terrace Street
Pittsburgh, PA 15261
412-647-3136
412-647-8060 (fax)
orrra@ccm.upmc.edu

DATABASE SEARCHES

National Library of Medicine PubMed Journal Search

FAMILY AND CAREGIVER RESOURCES

American Academy of Pediatrics (AAP)

• What is a Pediatric/Neonatal Critical Care Transport Team?. Developed by the AAP’s Section on Transportation Medicine, this document provides explanation on the need for and composition of pediatric-specific transport teams. (Accessed October 2009)

Pediatric Emergency Care

• Woodward GA, Fleegler EW. Should parents accompany pediatric interfacility ground ambulance transports?. Results of a national survey of pediatric transport team managers. Pediatric Emergency Care 2001; Vol. 17 (1), pp. 22-27

• Woodward GA, Fleegler EW. Should parents accompany pediatric interfacility ground ambulance transport? The parent's perspective. Pediatric Emergency Care. 2000; Vol 16 (6), pp. 383-90