COVID-19 hit North West London (NWL) early, placing unprecedented and uneven demand on its Intensive Care Units (ICUs). It became clear that high volume inter-hospital transfers would be required to dissipate capacity pressures across the region and prevent units from becoming overwhelmed. However, ICU transfers are highly complex, requiring specialist teams and intensive coordination – resources that individual units could not spare - and to perform this at scale presented a real challenge.

In response, the North West London Critical Care Network (NWLCCN) rapidly created an ICU ‘Transfer Hub’ to coordinate the strategy and logistics of capacity transfers. It was staffed by three doctors who communicated closely with ICU leads for real-time metrics on the fluctuating capacity pressures to plan the volume and destinations of patient transfers. An emergency bank of stand-by transfer volunteers was created, consisting of 69 critical care clinicians from across London, and the Hub partnered with a staff-bank management app to create a bespoke digital platform to facilitate shift scheduling and payment. This automation provided a way to onboard new staff swiftly and scale the bank with ease.

Between 17 March - 6 May 2020, the Hub coordinated the transfer of 238 patients, at its peak organising 13 patient transfers in a single day - the highest frequency of ICU transfers ever carried out in NWL.

These inter-hospital transfers were essential for NWL to cope with pandemic-driven ICU admission pressures and created greater equity of access to critical care for patients. The strengths of a network uniting to deliver mutual aid were maximised by having a single hub as the conduit to support information flow and co-ordinate decision making. Partnering with a tech platform and having access to key decision-makers were other enablers that allowed the Hub to innovate at pace and their experience has informed discussions about developing a pan-London ICU transfers service.