4. INTER-HOSPITAL TRANSFER OF AN ILLOBSTETRIC PATIENTS POSES
ANADDITIONAL RISK TO THE PATIENTHOSPITAL SARIKEI HOSPITAL SIBU
5. 1.DECISSION TO TRANSFER
6. EARLY AND APPROPRIATE REFERRAL Early referral O&G
specialist- DISTRICT MO BUDDY SPECIALIST- HEALTH CENTRES without MO
-->SPECIALIST Occasionally simultaneous referral to
otherspecialties may be necessary(eg:anaesthetist/ physician/
surgeon)
7. RISK OF TRANSFERRING? The decission to transfer patient in
remoteparts may be decided on the risk involved intransferring
(eg:night transfer) O&G specialist may decide
againsttransferring the patient or delay the transfertill the next
day if the risk of transfer is higherthan managing the case in the
referringcentre
8. 2. STABILISATION BEFORE TRANSFER
9. Ensure the patient is stabilised as best aspossible prior to
transfer1.IV lines/ branula2.IV infussion / bloods
10. 3. Medications- anti HPT, MgSO4, Inotropes4. Oxygen
support/ intubation5. In PPH- may need Bakri baloon
11. THE SPECIALIST SHOULD PROVIDE THEAPPROPRIATE INSTRUCTIONS
ORGUIDANCE TO THE REFERRINGDOCTOR/ NURSE
12. 3. MODE OF TRANSPORTATION
13. The following needs to be considered whendeciding on the
best mode of transportationa) Urgency of transferb) Condition of
the patientc) Availability of ambulance/ other mode oftransportd)
Distance and estimated transit timee) Time of day & weatherf)
MEDEVAC is an option but enquire first if itcan respond quickly
enough
14. 1.LAND TRANSPORTATION Distance to Hospital Sibu about 45
minutesto 1 hour Condition of road
15. 2. AIR TRANSPORTATION MEDEVAC- Decision should be discussed
with O&Gspecialist JKNS- Considerations include:1. Severity of
the cases2. Availability of the helicopter3. Weather
18. Ensure the ambulance or transport have therequired
resuscitative equipments that is ingood working order (availability
of oxygentank) Ensure the staff escorting the patient knowshow to
operate the resuscitative equipments
19. Ensure the appropriate medications(eg:MgSO4, parenteral
anti-HPT, sedatives,muscle relaxants) which are needed shouldbe
prepared in prefilled syringes Crossmatch blood products to bring
along ifindicated
20. If the patient is intubated ensure the Oxylogis functioning
or adequate oxygen tanks toensure the oxygen supply is adequate NG
tube is inserted to avoid aspiration duringtransfer
21. 5. PERSONNEL
22. Ensure that the relevant personnel arealerted early
(eg:ambulance driver, escortingMO/SN, blood bank staffs) In fact,
obstetric drills may include scenarioinvolving patient transfer All
escorting staff should have at leastaccreditation in BLS and
ideally passedSALSO They must be able to recognise and addressany
deterioration They must be familiar with drugs andequipment
involved during transfer
23. 6. HANDING OVER
24. This should be done systematicallythroughout all levels-
Escorting MO Referral centre MO/Specialist- Escorting SN/ MA
Referral centre SN Proper communication & documentation
isvital
25. Sibu Hospital Retrieval Team- Aim: to retrieve ill cases
from clinics ordistrict and bring them back to the
specialisthospital- The specialist/ consultant would make
thedecission if the retrieval team should beactivated and depends
on case to case basis
26. BENEFITS- O&G team can perform surgery in
districthospitals before taking patients back to thespecialist
hospital- Team can optimise patient during transfer- Team can
manage complications better duringtransfer- Additional blood
products- Anaesthetic doctor could come along in therelevant cases
DISADVANTAGES- Longer time taken to transfer patient
27. CHECKLIST BEFORE DEPARTURES1. INTUBATED PATIENT- Oxylog
functioning- Adequate O2 supply- ETT anchored- Suction machine-
Nasogastric tube- Oropharyngeal airways- High flow mask/ambubag-
Drugs-Muscle relaxantand sedation
28. 2. EQUIPMENT/MONITORING- SpO2/BP monitorbattery charged-
Infusion pumpscharged- Resuscitation bagcomplete3.MEDICATIONS- IV
MgS04- Anti- HPT- Inotropes- Crystalloids or Colloids-
Anti-emetic