How do you convince administration and doctors that certain pts need higher levels of care than what a small facility can provide? The past couple of weeks we have had several peds patients that really needed a pediatrician. (We only have family practice docs and some specialists that consult on patients). One peds pt is still in our facility and he/she is a very sick child. But the family doc think the patient can be managed at our facility.
And administration gets mad if we suggest transfer of some patients. One of my personal favorites is when a dialysis pt is admitted who is going to require dialysis the next day. We don't have dialysis at our facility. So after we go through all the paperwork of an admission (that takes over an hour if you do it correctly) the person will have to be transferred the next for dialysis. Or we get a fairly young person (40's-60's) who is having chest pain with no prior cardiac history...of course tuck them in at our place until cardiology comes through later in the day and decides to have them transferred for a cath. This stuff just aggravates me. Do all that paperwork and shazam! the patient is transferred...
We complain to our DON but she just turns a deaf ear....and the administrator just gets mad when we suggest a pt needs transfered to another facility. One time one of the family practice docs wanted to admit a 3 week old infant for something...I believe rapid resps and a cough. Our DON (who hasn't done bedside nursing since Florence was around with her lamp) said she would go down and determine if the infant was suitable for admission at our facility. Why not send one of the nurses who work WITH pts everyday and knows the strengths and limitations of the nursing staff go down and evaluate the infant? Because she knew we would say the kid needed transferred. And guess what? After 2 days the child was transferred to a larger hospital with a pediatrician.
Anyone else run into this problem at their rural facility? How does your administration and doctors deal with it? What determines if a pt stays or is transferred? (Of course some pts are obvious, even for our docs!). How does the nursing staff try to persuade a physician into transferring a patient? And convince administration the transfer was necessary? Any ideas?