Transfer Guidelines

ER Patient Transfers

Below is the transfer process, as brief as I can make it, recognizing this is an imperfect process (to have multiple processes). I thought about how to make this easier, but there really is no way to condense this summary except to say if you follow this process every time, you can never be faulted:

  1. receive call from outside ER.
  2. check with specialist
  3. complete pink form
  4. talk to AL who makes final decision to accept or decline the transfer (THAT IS NEVER THE ERMD DECISION).

 

 

NOW FOR ALL THE DIFFERENT PERMUTATIONS:

 

#1: For transfer requests from OUTSIDE Sharp system, follow our process:

  1. receive call from outside facility (any NON-SHARP facility)
  2. ERMD confirm with specialist that specialist is available
  3. complete pink form
  4. call AL who will make FINAL determination IF SMH will accept or decline the transfer. The AL will make this determination, NOT the ERMD. The AL will call the facility back to let them know if SMH will accept transfer/decline.

 

#2: For transfer requests WITHIN Sharp system

  1. receive call from GMT, CV, CORO.
  2. call specialist to let them know patient is coming (unless urology!!….see below). With the NEW SHARP INTERFACILTY TRANSFER ARRANGEMENT, we do NOT have to get approval from specialist to accept. We are only calling to inform specialist the patient will be coming and transmit relevant medical info to help in patient care. (WE can also send patients from SMH to other Sharp facilities if they have specialty coverage that SMH does not have — ENT, for example….provided the other Sharp facility has that speciality coverage).
  3. complete pink form
  4. call AL who will make final determination whether to accept the patient.

 

Sharp Coronado transfers:

  1. Please make it as easy as possible for Coronado to send patients to SMH. It is not the ERMD role, in Sharp Coronado transfer requests, to determine if the transfer is necessary, or why their hospitalist “can’t handle that case,” or why the ER doc “can’t handle the case,” etc, etc…..If they are calling to send us a patient, please just understand that they can’t handle the case, and let’s try to help them and the patient.
  2. That said, we still need to follow our general process. If Coronado is calling to transfer an ENT case, and we don’t have ENT on call that day, we should let them know we don’t have ENT on call and DEFINITELY refer the case to the AL immediately. With the Sharp Interfacility Transfer arrangement, Coronado may be able to send the patient to a different Sharp facility that has ENT coverage at that time.
  3. Always complete a pink form. Always call the AL to make final determination.

 

**********Sharp Coronado transfers – STEMI************* READ IT  READ IT    READ IT     READ IT

  1. Per Sharp System Protocol, the Sharp Coronado ERMD MIGHT choose to send a STEMI patient from the Coronado ER to the SMH. The Sharp Coronado ERMD might also choose to send the patient to a different cath lab — UCSD or Scripps Mercy, if they think that is best for patient care, based on patient stability.
  2. If the Sharp Coronado ERMD requests transfer to SMH, the SMH ERMD should confirm that our cath lab is open.
  3. We can then accept the patient, per EMTALA, as we are higher level of care, and it is the decision of the Sharp Coronado ERMD to choose where to send the patient. If you feel better pointing out that there are other closer cath labs that is your decision, but we are obligated to accept the patient, per EMTALA and per Sharp System protocol.
  4. Then fill out the pink form and alert the AL, as we do every single time on every transfer.