Transport of Critically Ill Patients —
Training activity: 8

Details

Perform transfer including troubleshooting as needed

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Surveillance of safe transfer and returning to the unit
• Communication with the clinical team
• Appropriate manual handling where required
• Patient centred care and support
• Patient packaging and dignity

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to safely and efficiently moving the patient while maintaining continuous monitoring and therapy, proactively assessing for changes, and effectively troubleshooting any issues that arise.
• Consider how the learning outcomes apply, specifically in relation to assessing and responding to changes in physiological variables or equipment performance during transfer, which requires critically analysing technical and clinical data.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the planned route, key transition points, roles and responsibilities of the transfer team, and common troubleshooting steps for transport equipment.

What is your prior experience of this activity?

• Think about what you already know about managing equipment and patient monitoring during movement and troubleshooting basic equipment alarms or malfunctions in a static setting.
• Consider possible challenges you might face during the activity, such as navigating tight spaces, unexpected equipment alarms, patient instability, or communication breakdowns.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you need to call for additional help, use contingency equipment, or abort the transfer.
• Acknowledge how you feel about participating in a transfer – excited, anxious about potential issues?

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as maintaining situational awareness during movement, rapidly assessing patient status and equipment function, or applying structured troubleshooting approaches under pressure.
• Identify the specific insights you hope to gain, for example, into the dynamics of a transfer team, effective communication during transport, or the practical application of troubleshooting algorithms.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of struggling with troubleshooting a specific alarm type or feeling communication could be improved.
• Identify important information you need to consider before embarking on the activity, such as the patient’s history and current status, the transfer plan, and contingency protocols.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst managing the patient and equipment during movement?
• Are you encountering situations such as:
  • Patient instability (e.g., sudden drop in blood pressure or change in respiratory status) or equipment malfunction (e.g., critical alarm) during transition?
  • Environmental difficulties (e.g., an unexpected obstacle in the route or communication issues with the destination team)?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to patient management by immediately initiating troubleshooting steps for an alarm?
• Consider the steps you are taking in the moment, such as:
  • Immediately pausing the movement to assess changes in physiological variables and remedy the issue
  • Consulting the transfer plan for contingency measures or seeking immediate support regarding patient management or troubleshooting
• How are you feeling in that moment? For instance, are you finding it difficult to manage equipment while navigating obstacles or troubleshoot complex alarms? Is it affecting your confidence in maintaining patient stability during the transfer?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving a technical issue by applying structured troubleshooting algorithms? Or are you needing support because the patient instability or equipment failure requires senior clinical intervention?
• What are you learning as a result of the unexpected development? For example, are you mastering effective strategies for managing equipment and troubleshooting in a dynamic environment? Or gaining insight into the critical nature of communication with the team during movement?

On action

What happened?

• Begin by summarising the key steps you took when performing the patient transfer, including phases like leaving the unit, transit, and arrival.
• Consider specific events, actions, or interactions which felt important, such as successfully troubleshooting an equipment issue (e.g., ventilator alarm) during transit, or coordinating complex movement through congested areas.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing movement to assess and remedy unexpected patient deterioration.
• How did you feel during this experience, e.g., stressed by the unexpected event or confident in your rapid troubleshooting skills?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding managing critically ill patients, equipment, communication, or unforeseen circumstances during transfer. What strengths did you demonstrate, e.g., effective communication with the MDT?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with a specific environmental challenge on the planned route?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in anticipating or reacting to issues or using planning tools for challenging environments?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the need to escalate patient care or equipment issues.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving your execution and troubleshooting during future transfers.
• What will you do differently next time you approach performing a patient transfer, for instance, by proactively reviewing the planned route for potential environmental challenges?
• Do you need to practise any aspect of the activity further, such as equipment troubleshooting, patient assessment, or communication during dynamic movement?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of participating in transfers with different patient acuities or transfer team compositions since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent transfer required urgent clinical troubleshooting (clinical or technical) forced you to re-evaluate the speed and structure of your initial response to patient/equipment change during your first attempt at this training activity.
• Considering what you understand about dynamic assessment, crisis management, communication under pressure and technical/clinical troubleshooting now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your response time and competence in troubleshooting patient or equipment issues during movement based on further learning and experiences? For example, how you proactively pursued advanced training in critical care transport or sought opportunities to manage more complex transfers.
• Has discussing specific transfer experiences, troubleshooting scenarios, or team dynamics or the impact of poor communication during movement on patient care with colleagues, senior staff, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a critical incident during a transfer provided new perspectives on decision-making and crisis leadership.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent transfer participation experiences, contributed to your overall confidence and competence in dynamic assessment, crisis management, communication under pressure and complex problem-solving/troubleshooting, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills in rapid assessment and inter-disciplinary communication now enables you to manage troubleshooting during transfer and discuss patient suitability with the multidisciplinary team in an OCE or DOPS assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to managing dynamic patient and equipment interactions during transfer? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer immediately when patient instability or equipment failure requires senior clinical intervention, recognising this necessitates immediate clinical escalation outside your scope of routine troubleshooting.
• Looking holistically at your training journey, how has this initial transfer performance experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to assessing/responding to changes, communicating effectively and applying equipment? For example, how this foundational experience has supported your development in leadership, teamwork, and complex problem-solving in high-stakes environments.

Relevant learning outcomes

#	Outcome
# 4	Outcome Apply, or remove, equipment during any stage of the transfer of critically ill patients.
# 5	Outcome Discuss and agree a transfer plan with the multi-disciplinary team ensuring the best interests of the patient, and all elements of their care, are considered throughout.
# 6	Outcome Communicate effectively with the patient, relatives and the multi-disciplinary team at all stages of the process.
# 7	Outcome Assess changes in the patients’ physiological variables, or in the equipment performance, during transfer; and remedy or apply contingency measures as required.