Roundey-roundey we go........the transfer merry-go-round

[TazziRN, RN]

Over the weekend I posted about a transfer from aych-ee-double-toothpicks I had because the first facility I contacted played the "If you can get So-and-so to accept him, I'll be happy to consult." Today I had a hydrocephalus pt who had surgery at this same facility last month. Called the ER, they do not accept ER to ER transfers. Got shunted to the house supe. Got the pager number for the neuro on call. He calls back, asks me what emergency room we are, says Thank-you-goodbye and hangs up!!

Call the house supe back, she hems and haws and says she'll see what she can do.

Find a name on the pt's pill bottles and I call her back, turns out the doc is a hospitalist. She gives me his number. I introduce myself and say "Please hold for my doc."

Between my ear and his, the guy hangs up!!!!!

House supe is wishy washy, doesn't want to do anything until I tell her that this is tantamount to a refusal and it is an EMTALA violation. She got the hospitalist to call us back but he says we need neuro.

Back on the merry go round..............I'm dizzy!

When I left we were waiting for a call back from the neuro guy again.

[hogan4736, BSN, RN]

As recently having been a night ER sup at a large urban neuro facility, I don't think that a pt, with a history of a neuro problem, and a current admittable diagnosis, belongs in my ED...

Sorry Taz, but I got these calls nightly (wanting to send VENTED pts to my ER, TPA'd pts to my ER, acute neuro surge issues to my ER)...

I wouldn't mind taking them on a slow night 9once a year :), but...they have a diagnosis, likely admittable, My ER is already overflowing (most other nights)...

sorry;

now, I work in a small town hospital in northern AZ, and sometimes we send to Vegas...

the pt deserves better than another ER "visit" waiting 6 hours for neuro in a 10 year old stretcher...

DISCLAIMER: when I received these calls, I did everything I could to facilitate a direct admit for the far away pt...

and, as the ED charge, if you told me that my neuro RESIDENT (we are higher on the food chain than they are) was hanging up on ANYBODY, my house sup would gave been all over him/her...

[TazziRN, RN]

My understanding of EMTALA is that ER to ER transfers are acceptable and that the higher level of care can get the specialist involved. This came about (I think) because specialists were refusing pts from smaller facilities.

When I worked at a tertiary center I felt the same way about transfers coming into the ER, but I felt that specialists should accept and do a direct admit. If the specialist won't even get on the phone, what else is there to do?

[hogan4736, BSN, RN]

I was just defending the need for all parties to try and make these direct admits...It's better for the pt...

Unfortunately, at that neuro hospital to which I was referring, neuro and NS RARELY accepted direct admits, and burdened the ED...

a peeve of mine

[P_RN, ADN, RN]

What burns me is the fact that the NURSE is put in the middle. Please wait for my doc....B S. Docs got voices, docs got ears they should talk doc to doc.

[hogan4736, BSN, RN]

actually P, the patient is the one in the middle...:stone