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Discussion

Transfer question

Hello all. I was recently approched by my VP who wants to know where to find the EMTALA or COBRA guidelines that states that one facility can transfer an inpatient to an emergency department. I have looked the web over and have found no such thing that says they can or can't. I have been told over the years that the transfering facility can transfer to an ED if it is a higher level of care. We have all come to accept that but my VP will want to see the document that states this is possible. Does anyone know of a guideline, link, or other materials to help me out?

Thanks in advance.

Task

Featured Replies

Funny that you ask this question today. I just read an article in the AJN last night about flight nursing and it referred to EMTALA consistently.

Here is the website given where EMTALA regulations can be found:

www.medlaw.com/regs.htm

The article I read described, quite well, the criteria for transferring. It was in the American Journal of Nursing. Volume 104, Number 12, pgs 49-53.

  • Author

Thank you. I will take a look at it.

Funny that you ask this question today. I just read an article in the AJN last night about flight nursing and it referred to EMTALA consistently.

Here is the website given where EMTALA regulations can be found:

www.medlaw.com/regs.htm

The article I read described, quite well, the criteria for transferring. It was in the American Journal of Nursing. Volume 104, Number 12, pgs 49-53.

  • Author

I have looked at the information that you provided and it still has nothing governing inpatient to emergency room transports. I will need to provide written prof that this is okay.

All help is greatly appreciated.

Task

I apologize in advance because I don't have printed documentation of what I'm going to say...

It's not so much the physical area that the patient is being transferred to, but the accepting physician & facility capabilities.

For example: Inpatient at rural hospital with diagnosis of XYZ. Will transfer to tertiary medical center with capabilities of treating XYZ, transfer accepted by Dr Imahero :). Patient arrives in tertiary center's ED for evaluation, admission, & bed assignment.

I worked in a very large government-run receiving hospital. Numerous times we would get a transfer into the ED that Dr Youknowwho had accepted for his service. ("Just have the trauma team clear him & give me a call, hon...":uhoh3:.

Anyway, that's my understanding of what you're talking about. Contact your facility's legal or risk management department. They should have access to the information you want. Good luck!

  • Experts

You can't find the rules because there are no rules -- EMTALA rules only apply to transferring patients out of EDs. The EMTALA regs were developed to address widespread instances of "patient dumping" by hospital emergency departments, and that's all they address. If a patient has been admitted to an inpatient bed and subsequently needs transfer, EMTALA doesn't apply (I've spent the last four years surveying and regulating hospitals for the Feds and my state, including enforcing the EMTALA regs).

You can't find the rules because there are no rules -- EMTALA rules only apply to transferring patients out of EDs. The EMTALA regs were developed to address widespread instances of "patient dumping" by hospital emergency departments, and that's all they address. If a patient has been admitted to an inpatient bed and subsequently needs transfer, EMTALA doesn't apply (I've spent the last four years surveying and regulating hospitals for the Feds and my state, including enforcing the EMTALA regs).

So an attending physician at Hospital A can transfer his/her inpatient to the ED at Hospital B? I guess EMTALA would apply if they discharged the inpatient & sent them to Hospital B's ED. But doesn't the word 'transfer' indicate a hand-off or agreement to continue care?

Are there Federal guidelines for this type of situation?

  • Experts
So an attending physician at Hospital A can transfer his/her inpatient to the ED at Hospital B? I guess EMTALA would apply if they discharged the inpatient & sent them to Hospital B's ED. But doesn't the word 'transfer' indicate a hand-off or agreement to continue care?

Are there Federal guidelines for this type of situation?

You would have to have the patient's informed consent, same as for any other "treatment", and there might be professional abandonment issues if Dr. Hospital A just sent the patient to Hospital B ED without saying anything to them, plus whatever ill will Dr. Hospital A creates between Hospital A and Hospital B if this happens often. There are Federal rules (in the CMS Conditions of Participation) about appropriate discharge planning and discharge instructions (making sure that the patient has the necessary follow-up care in place at the time of discharge) that would apply. Probably, also, several other kinds of issues that I'm not thinking of off the top of my head.

The EMTALA rules, however, do not apply at all to transfering a hospital inpatient to an ED or anywhere else. They only apply to patients being transferred from an ED to someplace else (whether another ED or an inpatient unit in another facility).

BTW, what kind of "transfer" is there from Hospital A to Hospital B other than discharging the patient from Hospital A? The use of the word "transfer" is kind of confusing or misleading, because, even when we're talking about sending people from one ED to another ED, they're still being discharged from the first hospital and admitted to the second hospital (unless, possibly, we were talking about two facilities owned by the same outfit -- but, even then, they would surely have separate provider numbers and it would be a discharge & admission situation ...)

Regardless of what Hospital A does (or doesn't do) prior to shipping an inpatient to Hospital B's ED, Hospital B's ED would have the same responsibilities to the patient that they would to any other individual who arrived at their ED that day. And Hospital B's ED would be responsible for meeting all the EMTALA requirements if they send they patient back to Hospital A or anywhere else.

"There are Federal rules (in the CMS Conditions of Participation) about appropriate discharge planning and discharge instructions (making sure that the patient has the necessary follow-up care in place at the time of discharge) that would apply. Probably, also, several other kinds of issues that I'm not thinking of off the top of my head."

Your above statement addresses my question. I understand that Hospital B's ED is held to the EMTALA regs. Thanks.

And I understand your comments about the term 'transfer'. Yes, those patients are technically discharged from one facility before being sent to another. Using the term 'discharge' makes one think that treatment is finished (follow-up is something else). The term 'transfer' brings to mind that one facility (or area) has done what they can & treatment will be continued in another facility (or area). Semantics actually... I think the conversation could go back & forth...

Thanks for the information & conversation. I enjoy reading your posts!

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