Turfing patients to other hospitals

[NextGen]

What are some of the reasons why your hospital's ED turfs patients to other hospitals? My ED often gets patients from outside hospitals for procedures that the outside hospital is capable of doing like a broken leg.

I understand turfing if the hospital is at 100% capacity or the patient does not have insurance. I DID NOT SAY THAT I AGREE - I JUST UNDERSTAND. What are some of the other reasons?

I really do want to understand why it happens.

Thanks

NextGenRN

[Nurse SMS, MSN, RN]

My hospital doesn't turf anyone. If we are full, we still take them and the nurses on the floors feel the push to move people around, discharge others, etc. I have had two patients now that I never should have because they belonged in ICU but there were no ICU beds. Disturbing.

[emtb2rn, BSN, RN, EMT-B]

We don't turf either.

[mmc51264, BSN, MSN, RN]

If we are full in the ED, we go to divert. That means we will only take a certain level trauma. We have had weekend nights where there have been 100+ pts waiting for beds. A few weeks ago the ORs were on divert because they had 3 transplants going. Unreal.

[Twinmom06, ASN, APN]

we get the turfed patients all the time. Since we are the trauma center we get those. Also, we get pts from the for-profit hospital system that they state they "can't" treat (but can but since the pts are Medicaid or no insurance they won't take them). We also get turfed from the local VA because they can't treat more than PNA (or so it seems).

[GrannyRRT]

The patient must be accepted by a physician at your hospital. If you want to know the reason for the transfer, ask the physician whose name is listed as the one accepting. You can bet that physician asked the other physician for a reason also.

There are many reasons for transfer. Unless you see the on call physician schedule for the other hospitals don't assume anything. Some people, even ambulance Paramedics, think our Children's hospital has an OB and delivers babies or that it should even when there is a perfectly good L&D 2 blocks away. Some EMS systems are obligated by protocol to take to the nearest hospital which isn't always the one of choice or the most appropriate.

[~PedsRN~, BSN, RN]

OMG, we get patients from all over the state. :) We are a highly regarded large children's hospital, so we get it all. I feel like some of the outlying hospitals now don't even attempt anything pediatric, they just send it to us - because we are here and available. Seriously. We get some of the dumbest things that should never even be admitted. I don't know if they are just over cautious or what. But its like they send them to us either healthy or dying. There is no in between.

[Esme12, ASN, BSN, RN]

There are many reasons a patient is transferred. A lack of insurance is not one of them. Sometimes a patient is transferred because of insurance. It isn't always "just a broken leg" It can be a complicated fracture involving important structures that the physician isn't comfortable with doing or knows someone who might do it better. Many times it is patient/family request to be close to other family members. It can be because the OR schedule is too booked. It can be because the facility is too full. It is important to note that Some states have gotten rid of diversion (MA being on of them) altogether.

There are laws that mandate what a transfer must be and certain requirements must be fulfilled.

In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.

It is called EMTALA/COBRA laws....Emergency Medical Treatment & Labor Act (EMTALA) - Centers for Medicare & Medicaid Services

There MUST always be a receiving physician accepting the patient and a bed open and available.

[HouTx, BSN, MSN, EdD]

Thanks Esme. I thought that EMTALA was so basic that every nurse would be familiar with it - but it looks like a reminder is always needed.

I know of 2 facilities that were 'sanctioned' in the '90's by the Feds for EMTALA breaches... the result is not pretty. They were cut off from all Federally funded reimbursement (Medicare, medicaid, champus, etc) for multiple years. One went completely out of business. I can't recall what happened to the other one. The staff & physicians who were directly involved were also penalized - I don't recall their specifics.

EMTALA is serious business.

[Anna Flaxis, BSN, RN]

We transfer (we do not "turf") patients to other facilities when we cannot provide the level of care the patient needs.

For instance, we do not have a cath lab, so STEMIs go to the nearest hospital with a cath lab.

Or, if we do not have any beds (actually, more like not enough staff), then we will transfer.

For urology patients, we will transfer.

For patients that need a neurosurgeon, we will transfer.

Etc. etc.

There are a lot of situations where we simply cannot provide the level of care the patient needs, so it is in their best interest to transfer them to a facility that can.

[Esme12, ASN, BSN, RN]

Thanks Esme. I thought that EMTALA was so basic that every nurse would be familiar with it - but it looks like a reminder is always needed.

I know of 2 facilities that were 'sanctioned' in the '90's by the Feds for EMTALA breaches... the result is not pretty. They were cut off from all Federally funded reimbursement (Medicare, medicaid, champus, etc) for multiple years. One went completely out of business. I can't recall what happened to the other one. The staff & physicians who were directly involved were also penalized - I don't recall their specifics.

EMTALA is serious business.

I was around when EMTALA didn't exist....I KNOW why they made the rule. I worked at a Catholic hospital....3 blocks over was the Methodist hospital who had the only paramedics in town and they had the only paramedic program for MILES!

They would actually turn ambulances away at their door for indigent patients. They would package and make lateral transfers based on insurance, or the lack there of, ALL THE TIME. Emergency rooms would trun away active labor patients becasue they didn't have a maternity floor...it was a real feces show.

[Esme12, ASN, BSN, RN]

We transfer (we do not "turf") patients to other facilities when we cannot provide the level of care the patient needs.

I just can't resist "The House of God" references...best book I ever read.

• To turf (verb: to find any excuse to refer a patient to a different department or team)
  
• To bounce (verb: a turf that has returned to its first department)
  
• Gomer (noun: "get out of my emergency room" - a patient who is frequently admitted with complicated but uninspiring and incurable conditions)
  
• LOL in NAD (noun: "little old lady in no apparent distress" - an elderly patient who following a minor fall or illness, would be better served by staying at home with good social support, rather than being admitted into a hospital with all the iatrogenic risks of modern medicine. Compare "NAD" = "no abnormality detected" or "no apparent distress" (used to record the absence of abnormal signs on examination).
  
• Zebra (noun: a very unlikely diagnosis where a more common disease would be more likely to cause a patient's symptoms - from the common admonition that "if you hear hoof beats, think horses, not zebras").
  
• Buff the charts (verb: to make a patient look well treated in the charts or medical records, without actually receiving any treatment.)
  

The House of God - Wikipedia, the free encyclopedia