Interhospital transfers

[miko014]

Do any of you get frequent interhospital transfers? I have gotten them before, but usually when they come, they are able to talk and tell me what's going on, and the facility that sends them calls me a report or faxes a continuity and I know what's going on.

Last night I got a lady - this is how great this was - and I don't even know what hospital she came from! Nothing said anything more than "Mercy" on it, and how many of them do you think there are? There was no address, no phone number, NOTHING! To make it better, they didn't call me any kind of report. All I had was the faxed copy of info they gave to the ambulance driver (scribbled - I couldn't read hal fof it, and I am usually pretty good at translating chicken scratch to English) and the copies of her chart (all her old orders and whatever). This poor little lady was MRDD so she couldn't answer any of my questions. She had a central line (at first I didn't know what it was - could have ben a permacath, could have been an IP...). They dress that stuff differently at the other hospital - we don't use gauze with our central lines - so it was all covered up, and the only thing I knew was that the date on the dsg was 6/8. And I didn't want to touch it if it was a permacath! And her poor stomach - she had tubes coming out everywhere! We had to guess what they were, and they had some crazy contraptions that I had never seen on them. It was a nightmare for me and the doc (a group of hospitalists took over her care) to try to sort all that out...all they told us was that she was coming in for "diarrhea". That's not a very good interhospital transfer reason, is it?? Anyway, it took me over 3 hours to dig through the chart and get all that settled and figured out. What would you have done in that situation? Have you ever had anything like that happen before?? :trout:

[miko014]

Oh yes - I forgot to add that our bed management dept didn't get much more info than I did, just that the pt's guardians had asked that the pt be transferred to our facility, and her admitting diagnosis was diarrhea, but she was having some complications from the treatment at the other hospital. They knew which hospital she had come from, but that's about it!

[Medic/Nurse, BSN, RN]

The RULES for LEGAL transfer of ANY PATIENT are clear. There are serious fines/penalty for those that do not follow them - this is a FEDERAL thing!

I WILL NOT take any patient from ANY referring facility that DOES NOT meet the requirements of TRANSFER. NEVER. EVER.

NOW, did she come in as an ambulance patient from an ECF or from another HOSPITAL that had the ability to care for her - but, the family "just wanted her at your hospital"?

Serious questions.

This should be reviewed PRONTO by YOUR FACILITY for possible EMTLA violations that were initiated at the referring facility.

This needs administrative/risk managements attention.

SAD. The patient deserved better from whomEVER sent her there - ECF or other acute facility!

[CraigB-RN, MSN, RN]

The RULES for LEGAL transfer of ANY PATIENT are clear. There are serious fines/penalty for those that do not follow them - this is a FEDERAL thing!

I WILL NOT take any patient from ANY referring facility that DOES NOT meet the requirements of TRANSFER. NEVER. EVER.

NOW, did she come in as an ambulance patient from an ECF or from another HOSPITAL that had the ability to care for her - but, the family "just wanted her at your hospital"?

Serious questions.

This should be reviewed PRONTO by YOUR FACILITY for possible EMTLA violations that were initiated at the referring facility.

This needs administrative/risk managements attention.

SAD. The patient deserved better from whomEVER sent her there - ECF or other acute facility!

EMTALA only goes into effect when the patient is an ER patient. If it's an interfacility, inpatient transport then it's not covered under EMTALA.

[suzanne4, RN]

Patients need to come with the appropriate paperwork filled out.

Transferrring a patient from another hospital for the treatment of diarrhea is not going to fly. Sounds more like the other facility was dumping.

There was an accepting physician at your facility that accepted this patient? If so, start with them and find out what they knew about this admission. They needed to approve it in the first place.

And definitely follow up with Administration at your facility. This is a major Risk Management issue if nothing else to start with. And should be unacceptable at your facility. This patient was just dumped and for the facility not to provide appropriate transfer documentation is unacceptable. The nurse that transferred the patient should have called report to you before the patient even arrived.

Way too may things that were done in this case, and it is now a patient safety issue. Contact Risk Management at your facility first thing Monday morning.

[miko014]

Yeah...the guardians of this pt are not family - it is an agency. They were the ones who wanted her transferred because, from what they told me, her care was incredibly substandard at the other facility. I guess they put in the central line without checking with the pt's guardians, and a lot of other stuff. I guess she went in for something minor and ended up with a lot of complications, and the guardians felt that her needs were not being met. That was why they requested that she be transferred to our hospital, so yes, it was inpt to inpt. The agency wanted her transferred so that they could get a different GI team working on her and try to straighten her out.

As for refusing to accept her, what could I do? They just plopped her down in the bed and handed me the folders (which I assumed contained the paperwork I needed). The "continuity" that I got basically said that the was fine, said a bit about her complications, and that was it. There was a minor procedure listed as what they did while she was there, and it did say something about "OR", but didn't say what surgery she had. It would be easier to explain if I could give more details, but I'm being careful 'cause of HIPAA...sorry if it doesn't make sense!

She was also there 2.5 hours later than they said she would be. I don't know if it would be a risk management thing or not, because technically all the information was there...I hope. I could not read the 100+ pages of chart copies that they sent with her, and even if I had time, a lot of it was just scribbled. You know, the kind where, if you know what's going on, you could probably make it out, but since I had no idea.....yeah. Not a good situation at all. I'm going to talk to my boss about it on Monday.

As for the doc, thank goodness he was there. I don't think he knew she was MRDD. He came in while we were getting her cleaned up and trying to change her dressings and stuff - we worked out what all the tubes were while he was there, and then he took the paperwork that the other facility sent and got her meds and stuff straightened out. Then I took the paperwork they sent and tried to weed through it so that I could get all of her admission information into the computer - I think I spent 3 hours just on that admission alone, not to mention the time talking with reps from her agency and changing all those dressings!

[Altra, BSN, RN]

Patients and/or those responsible for their health care decisions do have the right to request transfer/treatment at another facility for any reason they choose. What is needed is for a physician at the receiving hospital to accept the patient and for the patient/guardian and physician at the transferring facility to sign some type of paperwork that indicates the reason for transfer, names the accepting physician at the new hospital, and contains the transferring physician's statement that the patient is stable enough for transfer.

Working in a trauma center, I receive patients from outlying hospitals all the time. The quality of the communication runs the gamut from terrible to excellent.

[Medic/Nurse, BSN, RN]

Yes, CraigB - I will correct this - EMTLA does cover the ER patient and the OB patient in active labor.

Even without EMTLA - I will still not load the patient - this includes NICU, Peds - well, anything without knowing that it is being done right!

Loading an inpatient on a general floor and transferring to a general floor at another facility most surely WOULD /COULD be viewed very unfavorably in the event of NO consent, MD to accept, bed available, etc. Plus, don't EVEN get me started on me standing on a general floor (with a loaded patient) that would decline the patient (on my stretcher) and REFUSE to accept them! Bad mojo wouldn't EVEN begin to cover this!

Standards for any Transfer that I take - Includes:

1. Consent

2. Receiving MD

3. Space available

4. Nurse to nurse report is done

5. All pertinent records are transmitted

6. I receive report as well

Virtually ALL of my transports at this stage in my career ARE covered by EMTLA.

Now, when we get to the normal EMS requests - yes, the rules can differ - but inter-facility (non emergency --- 911 calls from the ECF's an exception) must still follow 1 - 6 above or I am not going.

FYI - I have had my A** ripped by more than one receiving facility for ISSUES that I was NOT any PART OF. SO, in the interest of the patient, my license - I have my standards. Also, my SOP's.

And I can always defend my practice. Action and Inaction.

Practice SAFE!