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We accept referrals 24/7. You will be asked which hospital you are calling from and some basic patient demographic information prior to entering a call conference with our Duty Co-Ordinating Consultant (DCC).

For all Time Critical and Urgent Escalation of Care referrals please refer directly by telephone.

Please use referapatient for all Repatriation, Continuation of Care, Capacity and planned Escalation of Care referrals ONLY.

Following this the Duty Co-ordinating Consultant will call you to discuss the referral.

Please use the preparing for transfer checklist below to ensure your patient is ready for transfer.

What information do I need?

This checklist will allow you to prepare the information you will be asked for during the referral.

Urgency of transfer

All of our transfers are categorised according to nationally-agreed criteria:

• Time critical: patients requiring transfer to specialist care for immediate (within 1 hour of arrival) life, limb or sight-saving intervention to reduce risk of imminent death or severe or long-lasting morbidity.
• Urgent: patients requiring transfer for ongoing time-sensitive management to reduce risk of death or significant morbidity.
• All other patients who require transfer for elective intervention, ongoing care, repatriation or capacity reasons do not typically have a time element.
  

Preparing for ACCOTS’s arrival

Most patients requiring a ACCOTS transfer will benefit from support from your ICU/anaesthesia teams. Ongoing resuscitation and stabilisation, if required, must continue to occur whilst ACCOTS are en-route. 

The preparing for transfer checklist is designed to help you rapidly and efficiently prepare your patient for the ACCOTS team’s arrival. In our experience it significantly reduces the stabilisation and packaging time. 

We advocate the use of the Intensive Care Society’s Standard Medication Concentrations. 

Please inform the patient’s next of kin they are being transferred.

Blood products

If a patient requires ongoing blood transfusion, we will discuss this during the referral and the Duty Co-Ordinating Consultant may ask you to order blood to be available in a transport box for transfer. 

What happens when the ACCOTS team arrive?

When the Accots team arrive, they will introduce themselves and identify the clinician(s) in charge of the patient. After confirming patient identification and receiving handover they will take clinical responsibility for the patient. 

When patients are time critical and urgent, the ACCOTS team will work rapidly to expedite the safe transfer of the patient in order that they receive the care they need in the receiving hospital as soon as possible. For time critical patients, the team are aiming to depart within 20 minutes of arrival..

What happens if ACCOTS are unavailable or too far away?

When the team are already committed on another transfer, calls continue to be triaged and coordinated by ACCOTS.

If possible, and clinically appropriate (eg. non-time critical, repatriation and capacity transfers), the Duty Co-Ordinating Consultant will hold a referral as ‘Pending’ until the next available opportunity arises for an ACCOTS team to complete it. This reduces the resource burden on your hospital and EMAS/WMAS.

If the transfer is Time Critical in nature and therefore cannot wait you will be advised to call 999 and request an emergency ambulance from EMAS/WMAS.

Remember an appropriately trained and experienced medical team from your hospital will need to accompany the patient.

What happens overnight?

ACCOTS triage and coordinate calls 24/7. Overnight, referrals that require a time critical or urgent transfer will receive an appropriately urgent ACCOTS ambulance, dedicated Transfer Practitioner and transfer equipment.

We will ask you to provide a suitably trained and experienced medical escort (usually registrar grade doctor or above) to accompany them.

We will arrange their return journey where possible, but this cannot be guaranteed.

Additional equipment (e.g. IABPs)

Occasionally patients require specialist equipment that ACCOTS do not carry. In such situations, when there is a requirement for this device to continue to be used, it may be necessary to transfer the patient with this piece of equipment. 

The ACCOTS team will clean the device, ensure its safety and usually return it to the referring hospital, however this may not always be possible. 

Where this is not possible, the device will be returned to the relevant ACCOTS operational base where collection can be arranged the next working day.

Responsibility for arranging collection and any costs incurred are borne by the referring hospital.

Long distance transfers

ACCOTS frequently undertake transfers to hospitals outside the East and West Midlands. Time-critical and urgent transfers (e.g. for specialist liver and cardiac care) can occur across the 24 hour period and the team will do their best to support these.

Some patients require repatriation to distant locations. These transfers are rarely time-important and we welcome early contact so that we can discuss these cases in detail. This may mean we arrange a short case conference so we can better understand the patient’s needs.