GIRFT has produced a checklist of key actions and considerations for NHS elective surgical hubs when developing inter-facility transfer processes and pathways for critically ill patients. 

The practical guide lists essential protocols for moving critically ill or deteriorating patients, both adults and children, from a surgical hub to an acute hospital with the appropriate facilities required for their ongoing care. 

It is aimed at clinical teams in NHS elective surgical hubs to support their work with colleagues in acute trusts, critical care networks, ambulance and transfer services in delivering appropriate escalation pathways and local transfer arrangements. 

It offers high-level guidance and should be used alongside national guidelines and local policies. As a checklist it outlines the essential steps all hubs should take to ensure a successful transfer including processes for identification, escalation and prioritisation of critically ill patients for transfer. Key areas of focus are: 

• Informed consent for undergoing surgery in a hub without access to critical care. 

• Early-warning identification and escalation of deteriorating patients. 

• Prioritisation of transfers, including defining clear transfer thresholds. 

The guide also highlights additional elements that would enhance the inter-facility transfer process such as human factors training and digital tools that support observation tracking and shared patient/ clinician decision-making.  

Roughly half of all NHS surgical hubs are reported as ‘standalone’ surgical units in a dedicated building which is fully separate from any acute provision. While hubs are primarily for low-complexity and low-risk patients, the number of transfers from surgical hubs to other sites is expected to increase as the quantity and activity of hubs increase, alongside the provision of more complex surgeries in higher-risk patients. 

GIRFT’s clinical leads, Mike Swart and Chris Snowden for anaesthesia and perioperative medicine and Anna Batchelor for critical care, worked with ten elective surgical hubs and consultant anaesthetist Zara Townley from Lancashire Teaching Hospitals NHS Foundation Trust to produce the guide.