Appendix 3
Referral and transfer arrangements and resource readiness
Principle
Each healthcare organization must establish in advance which emergency urological procedures it can provide around the clock, which are available only during limited hours, and which require transfer. The pathway must be known to the emergency department, on-call service, emergency medical services, operating suite, and receiving unit.
Resource readiness matrix
| Resource | What must be established | Action if unavailable |
|---|---|---|
| Specialists | Round-the-clock availability of a urologist, anesthesiologist/intensivist, and surgeon/trauma specialist; arrangements for involving a pediatrician, obstetrician-gynecologist, nephrologist, radiologist, and clinical pharmacologist. | Early remote consultation and transfer to an organization with the required expertise. |
| Diagnosis | Availability of laboratory testing, microbiology, ultrasonography, CT, and image transfer to the receiving team. | Use available investigations for initial stabilization; transfer without waiting for a nonessential investigation if delay is unsafe. |
| Procedures | Operating room, endoscopic equipment, and the ability to provide drainage, hemostasis, and anesthesia. | Do not intervene beyond the team's competence; stabilize and agree on acceptance and transport. |
| Intensive care | Monitoring, vasoactive support, respiratory support, transfusion support, ICU. | Transfer through the agreed pathway with an appropriate medical escort. |
| Interventional radiology | Actual round-the-clock or limited availability, call-out arrangements, and an alternative center. | Surgical consultation and transfer to a center offering the required procedure. |
| Medication supply | Local formulary, antibiogram, antidotes, emergency drugs, and arrangements for obtaining a drug in short supply. | Use an approved local alternative and consult a clinical pharmacologist; transfer if the necessary treatment is unavailable. |
| Transport | Emergency medical and air ambulance contacts, criteria for a medical escort, and handover arrangements. | Support the patient until transport arrives; document changes in condition and actions taken. |
Sequence for arranging transfer
1. Identify the unavailable resource or expertise and the urgency of transfer.
2. Begin the necessary initial stabilization and monitoring.
3. Contact the receiving organization and provide structured clinical information.
4. Document acceptance, the responsible specialist, and the agreed transfer pathway.
5. Determine the mode of transport and required medical escort.
6. Prepare documentation, investigation results, images, the medication list, and device details.
7. Transfer the patient with structured verbal and written information; record departure time and condition at handover.
Required elements of a local pathway
- a list of healthcare organizations and units accepting adults, children, pregnant patients, and patients with multiple injuries;
- round-the-clock contacts and the process for confirming acceptance;
- availability of CT, an operating room, endoscopy, interventional radiology, ICU, microbiology, and transfusion services;
- responsible roles at each stage of the pathway;
- arrangements for transmitting images and medical records;
- a backup pathway if the primary center is unavailable;
- a process for reviewing delays, refusals to accept patients, and other pathway failures.