Transfer codes to ER not ICU

Published

Is it an EMTALA violation to send stroke "codes" to the ER from the hospital floor and to be evaluated, treated and then kept down there for long periods of time.... sometimes days cause there are no ICU beds available?

Up Vote Up Vote ×
Specializes in Critical Care.

From what I understand, EMTALA doesn't control what dept of the hospital treats a person. Now if they tried to discharge a patient that is having a stroke because they can't pay for it, that would be EMTALA violation. Or if the hospital tried to transfer the patient before stabilizing the patient to the best of their ability, that would be a violation.

Why do you feel that it is an EMTALA violation to tranfer them to the ED, where they can handle a critical patient?

Up Vote Up Vote ×
Specializes in OB, ER.

You are not allowed to do that! In fact an ER can not accept a transfer from another inpatient hospital bed to the ER either. They can go ER to ER but not impatient to ER in the facility or from different ones.

Up Vote Up Vote ×
Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

I can see this happening - if there are *zero* ICU beds and this is a stroke patient that *needs* an ICU bed, then this is a patient that needs to be somewhere that you have staff that are ventilator capable, able to run vasopressors, etc... which is not something you can do on a floor. Generally, you can downgrade at least 1 patient out of an ICU to make room for someone else, but if you've got a full house, and you need that patient to be in a place that can medically manage them, they are too unstable to transfer out - then the ED would be the best place for that patient next to an ICU environment. Granted, the ED is not an ICU, I doubt the ED would appreciate housing that patient - but it sounds like the patient needs a level of care that cannot be provided on a floor... Insurance or not.

Up Vote Up Vote ×
Specializes in ER.

Yes yes yes this is an EMTALA violation. EMTALA considers any inpatient floor a higher level of care than the ED. So in their eyes, the general medical floor is a higher level of care, although we know the ED truly is. An ED is more than capable of providing critical care, just not for days on end like an ICU.

Up Vote Up Vote ×
Specializes in Trauma/ED.

A long argued topic and in my opinion a really bad precedence to set...in my facility we have adamantly refused to take patients back from inpatient units. The last time I ran into this we had sent a patient to our admit unit, they went to the GI lab where they decided to have a STEMI, the GI lab tried to send the patient back but there would be no way to put in orders and the paper trail for billing would have been fragmented so I sent staff there (both from our cath lab and from the ED). I told them I would not take the patient back but that I'd be happy to send them all the help they needed...pt went to the cath lab in less than 30 minutes from dx.

Just realize that it could be interpreted as an IMTALA violation...whether it would be has been debated. From ICU to ED could be considered a lower level of care. Does your ICU send patients to ED's in other hospitals? My bet would be NEVER...

Hospitals transfer from ED to inpatient, ED to ED, or inpatient to inpatient...not inpatient to ED.

Up Vote Up Vote ×
Specializes in ICU.

My hospital rents 3 floors to other facilities - 2 behavioral health floors and 1 continuous care/rehab floor. If they have a patient code, the patients have to go to the ER before being admitted to our ICU - I understand it's a different facility so they can't really do in-house transfer orders...but we do direct admits all the time from other facilities, I don't understand why we can't handle these situations like those?

Our code blue team responds to codes on those floors (since they're not equipped with the staff to handle them)...but we stabilize and then move them to the ER, and then they go to our ICU. Now a patient that is on one of our general med/surg floors that codes would go straight to ICU...I've never heard of one of our admits going to ER before ICU.

Up Vote Up Vote ×
Specializes in ER, Trauma.

It just comes down to where the patient can get the most appropriate care for his/her medical needs. When all is said and done, that's how it'll be judged.

Up Vote Up Vote ×
Specializes in ER.
My hospital rents 3 floors to other facilities - 2 behavioral health floors and 1 continuous care/rehab floor. If they have a patient code, the patients have to go to the ER before being admitted to our ICU - I understand it's a different facility so they can't really do in-house transfer orders...but we do direct admits all the time from other facilities, I don't understand why we can't handle these situations like those?

Our code blue team responds to codes on those floors (since they're not equipped with the staff to handle them)...but we stabilize and then move them to the ER, and then they go to our ICU. Now a patient that is on one of our general med/surg floors that codes would go straight to ICU...I've never heard of one of our admits going to ER before ICU.

Although my hospital does not rent out space, any codes in behavioral health or the rehab floor go to the ED, since they are considered "outpatient" in the grand scheme of things, even though they are in the hospital. Just to make more confusion :uhoh3:

Up Vote Up Vote ×

I was told by ICU RN's ( my friends) that this is an EMTALA violation. I cant find anything on it though. What EMTALA seems to address is Emergency Room and EMS issues not inpatient hospital issues. If anyone knows where I can find this in EMTALA please let me know. Thanks for all the input

Up Vote Up Vote ×
Specializes in Trauma/ED.

Interesting find when I looked this up:

"Once the patient is admitted and stabilized, the EMTALA obligations end, under the 2003 regulations and as clarified in the 2008 amendments. A new emergency medical condition which arises thereafter, or a decision to transfer the patient, does not invoke EMTALA" http://www.emtala.com/faq.htm

I learned that it was the level of care that was the issue with EMTALA (from higher to lower) but this may not be the case...interesting.

Up Vote Up Vote ×
Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Although I can't seem to find it specifically adressed I was always under the understanding that this was a COBRA violation. Unfortunately all I can find on COBRA addresses employee insurance coverage. I'm pretty sure that there would be some significant insurance issues and ensuing payment problems since you cannot be charged as both an inpatient and an outpatient in the same 24 hour period. The overarching patient care issues are just as complex if not more. I personally believe that it would be in the patient's best interest to be stabilized on whatever unit they were on and if no ICU bed is available then transfer them to another facility that has one. Sending them to the ER where they will NOT receive the one-on-one care they deserve is completely unacceptable and smacks of an institution that is watching their wallet rather than watching out for their patients.

Up Vote Up Vote ×
+ Join the Discussion