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

[Do-over, ASN, RN]

Love House of God. Read it again a couple years ago - it renews my sympathy for new docs. I especially love the patients whose charts are buffed are the ones that did the best =)

[Laurie52]

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. 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.

If you truly believe that patients are never transferred for a lack of insurance I have a bridge to sell you:) There is always the "reason" a patient is transferred such as there is no doctor who is able to manage rib fractures but it most frequently happens when patients do not have insurance.

[GrannyRRT]

If you truly believe that patients are never transferred for a lack of insurance I have a bridge to sell you:) There is always the "reason" a patient is transferred such as there is no doctor who is able to manage rib fractures but it most frequently happens when patients do not have insurance.

The patients with no insurance who are taken to a larger center will probably do better than the person with excellent insurance who is kept at a hospital for that reason and be at the mercy of a doctor who can but probably shouldn't.

[Laurie52]

The patients with no insurance who are taken to a larger center will probably do better than the person with excellent insurance who is kept at a hospital for that reason and be at the mercy of a doctor who can but probably shouldn't.

Very true, but sometimes I would like honesty instead of all the games that are played. You would not believe the number of patients who. Ago ally get sicker just before a holiday weekend

[Laurie52]

Love spell check, that would be magically sicker. . .

[Esme12, ASN, BSN, RN]

If you truly believe that patients are never transferred for a lack of insurance I have a bridge to sell you:) There is always the "reason" a patient is transferred such as there is no doctor who is able to manage rib fractures but it most frequently happens when patients do not have insurance.

I never said I didn't believe it happens nor did I say that it didn't happen. If they are caught there are fines to pay...here's the glitch hospitals don't have to self report so if they are owned by the same "system" it's all good. If they get caught laterally transferring and reported the fines start at around $250,000.00.

Believe me...or not...I lived those days (it seems so have you) and the rule it has stopped a large percentage of this behavior.

[GrannyRRT]

Very true, but sometimes I would like honesty instead of all the games that are played. You would not believe the number of patients who. Ago ally get sicker just before a holiday weekend

I can see the holiday weekend thing. It will depend on who is covering and some places might not have coverage.

Patients might go to the ER before the weekend.

ER to ER transfers are alot easier than after the patient is admitted. Once a patient is admitted and if they don't have the right insurance, that patient may not get the opportunity to be transferred to the more appropriate center.. Finding a doctor for transfer acceptance after admission might be difficult and bed availability might be "said" to be nonexistent as they keep beds open for admits from their ER. Most complex diagnoses are not made in the ER. It might take several days for the transfer to happen and some patients can become train wrecks quickly even if they seemed to have what you thought to be a minor complaint in the ER. The physician may see it differently.

You could also have a patient in the ER with one of the managed plans like Kaiser who will refuse a cardiac cath at your facility during their AMI/STEMI. They will try to take a cab if they have to based on their understanding of their insurance no matter how many times you explain "emergency".

In an ideal world, wallet biopsy should not be the primary diagnosis.

[Fiona59]

I work in a hospital that is a regional centre. We take patients from the Arctic, Yukon, NWT, parts of Manitoba, SK, BC and our own province. If the docs up north can't handle their patient they are flown to us.

It affects the beds available for local residents. It can be a nightmare. Even though the home province is responsible to payment of transfers, we still have beds blocked by out of towners due to transport disputes.

High risk and multiple births are flown down to us which can result in NICU bed shortages. Assaults, workplace injuries.

I dread long weekends because of accidents and small town hospitals shipping them out

[Ruby Vee, BSN]

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.

EMTALA may indeed be so basic that every ED nurse knows about it. Maybe even every nurse who has been to nursing school since the 90s. But I went to school in the 70s, never worked in ED and don't know about it. (Thank you Grn Tea!)