Transport of Critically Ill Patients —
Training activity: 9

Details

Reconnect patient to all essential equipment on return to critical care

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

• Monitoring ventilation for changes, including all alarm status reports
• Communication of discrepancies with the clinical team
• Reporting of adverse incidents following transfer
• Reflection on success of the transfer and lessons learned

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 transferring the patient from transport equipment to the static critical care equipment, ensuring all essential monitoring and therapy is seamlessly re-established and functioning correctly.
• Consider how the learning outcomes apply, specifically in relation to applying and removing equipment and understanding the importance of verifying equipment function and patient response after reconnection.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the local protocol for receiving a patient back into critical care, including the order of reconnection, verification steps, and handover process.

What is your prior experience of this activity?

• Think about what you already know about connecting static critical care equipment (e.g., ventilators, monitors, pumps) and assisting in receiving patients back from procedures or transfers.
• Consider possible challenges you might face during the activity, such as managing multiple lines and tubes, ensuring correct equipment settings are resumed, or patient instability during the transition.
• 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 assistance from nursing staff, the medical team, or respiratory therapists during the reconnection phase.
• Acknowledge how you feel about this phase of transfer – confident in managing the transition?

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as efficiently managing equipment connections during the transition or effectively verifying equipment function and patient response post-reconnection.
• Identify the specific insights you hope to gain, for example, into the critical steps for ensuring safety during the transition or the impact of efficient reconnection on patient stability.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of difficulty managing the physical space around the bed or ensuring all therapies were resumed.
• Identify important information you need to consider before embarking on the activity, such as the patient’s current status and required static equipment settings before they arrive, and ensuring the static equipment is prepared and ready.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst transitioning the patient from portable equipment back to static critical care systems?
• Are you encountering situations such as:
  • Difficulty identifying connections or ensuring correct settings are resumed on the static equipment?
  • Patient instability (e.g., haemodynamic shift) or equipment not functioning upon reconnection?
  • The critical care team raises immediate concerns about the transition process or documentation?

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 the sequence of reconnection based on patient priority or equipment function?
• Consider the steps you are taking in the moment, such as:
  • Immediately verifying all static equipment settings against the transfer plan or patient’s requirements
  • Seeking immediate support from the critical care team or a colleague regarding patient status or equipment management during the transition
• How are you feeling in that moment? For instance, are you finding it difficult to manage multiple lines/cables or verify settings on new equipment? Is it affecting your confidence in safely re-establishing full monitoring and support?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully transitioning the patient to static support and verifying that all essential equipment is functioning? Or are you needing support because equipment failure or patient instability requires senior clinical intervention?
• What are you learning as a result of the unexpected development? For example, are you mastering a more efficient and safe sequence for reconnecting equipment? Or gaining insight into the intricacies of safely handing over patient care?

On action

What happened?

• Begin by summarising the key steps you took when reconnecting the patient to equipment upon return to critical care.
• Consider specific events, actions, or interactions which felt important, such as successfully managing the rapid switch from portable to static ventilation or verifying all monitoring parameters were accurately re-established.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the reconnection sequence to manage unexpected patient instability or haemodynamic shift.
• How did you feel during this experience, e.g., focused on precision and speed or anxious about securing all essential lines?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding managing the return phase of transfers and reconnecting critically ill patients to equipment. What strengths did you demonstrate, e.g., accuracy in applying static equipment?
• What skills and/or knowledge gaps were evident, e.g., difficulty managing line management during the transition phase?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in ensuring seamless transitions and verifying equipment function?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the handling of unfamiliar monitoring equipment used by the transport team.

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 process for reconnecting equipment after transfer.
• What will you do differently next time you approach the return phase of a transfer, for instance, by proactively ensuring the destination area is clear and the static equipment is prepared and checked prior to patient arrival?
• Do you need to practise any aspect of the activity further, such as techniques for ensuring seamless transitions or verifying patient status post-reconnection?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of participating in post-transfer reconnections 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 reconnection suffered delays due to errors in equipment handover or sequence forced you to re-evaluate the efficiency and sequence of your initial reconnection process during your first attempt at this training activity.
• Considering what you understand about organisation, continuity of care, and managing transitions 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 systematic approach to checking connections and ensuring continuity of monitoring/therapy based on further learning and experiences? For example, how you proactively advocated for improved handover protocols or contributed to checklists for post-transfer procedures.
• Has discussing efficient and safe post-transfer processes or equipment handover or the impact of reconnection errors on patient stability with colleagues or the wider multidisciplinary team changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a situation where reconnection issues impacted patient care deepened your appreciation for logistical processes in critical care.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent post-transfer reconnection and handover experiences, contributed to your overall confidence and competence in organisation, attention to detail during transitions, and managing patient handovers, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in systematic checking and ensuring continuity of monitoring and therapy now enables you to manage patient handovers and verify equipment function during relevant assessments.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to managing equipment during patient admissions and transfers? 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 equipment failure or patient instability requires senior clinical intervention during the transition, recognising this falls outside routine equipment management scope.
• Looking holistically at your training journey, how has this initial reconnection experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying/removing equipment, discussing the plan and assessing/responding to changes? For example, how this foundational experience has supported your development in process management and ensuring patient safety through technical procedures.

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.