Abstract
Background and aims: Joint Statement from the Society of British Neurological Surgeons (SBNS) and the Royal College of Anaesthetists (RCoA) states the need for clear instructions for referral and management of time critical neurosurgical emergencies to avoid any delays which could cause harm. Following a patient death we conducted an audit to identify delays in transfer. Lessons learnt from audit will be used to improve our local guideline.
Method: Retrospective case note review of PICU patients with time critical neurosurgical emergency who died between 2004-2010. Any delays in transfer were identified
Results: 12 patients: causes of raised intracranial pressure included trauma (2), acute intracranial bleed (4), intracerebral abscess (2), new tumour (2), blocked VP shunt (2). Median time from referral to retrieval team (local or regional) leaving to transfer patient to PICU was 2.625 hours. Delays identified: delay in CT (5/12); referring unit asked ‘can you bring?’ (10/12); local team unable to bring (6/12); ‘stay & play’ not ‘scoop & run’ (8/12); late involvement neurosurgeon (2/12); geographical factors (2/12); difficulties with CT image transfer (3/12)
Conclusion: Without clear guidelines including explicit instructions on how to perform a time critical transfer, transfer teams (local or specialised) will adopt a safe, modified ‘stay & play’ policy which can result in delays which may lead to patient harm. Effecient CT image transfer between referring unit and lead centre to allow neurosurgeon to determine whether a patient needs a time critical transfer important. Education/training on new guidelines and re-audit of transfers needed.
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Koyalakonda, C., Parkins, K., Mahoney, S. et al. 1449 Where Does the Time Go? Identifying Delays in Transfer of Patients with Time Critical Neurosurgical Emergencies to Enable Effective Change. Pediatr Res 68 (Suppl 1), 716 (2010). https://doi.org/10.1203/00006450-201011001-01449
Issue Date:
DOI: https://doi.org/10.1203/00006450-201011001-01449