Transfers who go POV

[Lunah, MSN, RN]

Hi ER peeps! Was just having a discussion about transfers who are allowed to transfer by privately owned vehicle (POV). The situations I am thinking of are usually when a specialty (e.g., peds ortho) is not available at Hospital A, but the parents want to drive their stable kid and not pay a fee to transfer to Hospital B, and they are still marked as a transfer in the record, report is called, etc. So everything is done correctly except that the patient is not transferred by EMS/healthcare transport.

Does your ER allow this? If so, how is it handled? Or would your facility discharge them as leaving AMA?

I have my own opinions on doing it "the right way" for liability's sake, but I am curious to see if anyone has policies in place that allow for transfer via POV.

[Anna Flaxis, BSN, RN]

We do this quite often, as we are a small hospital and specialties are frequently unavailable. How we handle it depends. For instance, if it's an interfacility transport, we handle it like an EMTALA transfer except they go POV. If the specialist wants the person to come to their clinic, or meet them at the ED of the other facility, then we discharge them. We only ask them to sign AMA if the physician does not agree with their wish to go POV. If the physician thinks it is safe to go POV, then we do not ask them to sign AMA.

[Nalon1 RN/EMT-P, BSN, RN]

For the most part it is up to the physician. Most do go by ambulance, and if they refuse, they are done as AMA (but all transfer stuff still done).

The last one that went POV was a pt with a brain tumor. Only reason he came to the ER is his ophthalmologist did an exam and found the pt could not see to the right periphery in the right eye, pt did not even realize that they had a problem. Family was there and they went POV to the neuro unit downtown.

[Medic2RN, BSN, RN, EMT-P]

In one of my ERs, we have a liability waiver form that the patient signs if they decide to travel POV. If the physician disagrees with the POV transfer and the patient refuses an ambulance transport, then we fill out the AMA and explain everything to the patient. Most patients do travel via ambulance though.

[Altra, BSN, RN]

With rare exception, if a patient refuses transfer, they are discharged or must sign out AMA. The exceptions tend to be kiddos that should be admitted to the local children's hospital.

I'm not the expert on all things compliance-related, but how do you make this work in terms of EMTALA?

[Lunah, MSN, RN]

I'm not the expert on all things compliance-related, but how do you make this work in terms of EMTALA?

I think it comes down to stable vs. unstable. As I understand it, if your patient is stabilized, the EMTALA obligation is finished.