Harbor:ED to Rancho Los Amigos (RLA)

• ED to RLA (2/4/2026) for patients 18 y/o and older
  • Stable vs Unstable
    • If unstable for transfer, admit!
    • For now, no ICU admissions from ED to RLA (HUMC ICU can consider lateral transfers)
  • DHS vs OOP
    • If OOP, transfer to in-plan hospital
      • UR needed for approval prior to transfer center, or transfer center doing the financial screening?????
    • If DHS or approved for admission, proceed to next step
  • To initiate transfer
    • Place Orchid order for "Consult to Transfer Center"
      • Enter the following info:
        • Requested level of Care
        • HUMC attending
        • Reason for transfer: "Acute medicine (Rancho Los Amigos)"
        • Patient Consented for Transfer (yes/no) - I would verbally consent, then do written EMTALA if patient accepted
        • Provider name/Call Back Number
        • Is the patient receiving chemotherapy (should be "no")
      • MAC will inform us if there is no capacity for this level of care at RLA
      • RLA MOD/HOD will call back within 15 minutes for doc-to-doc/review and exclusion criteria
      • If the patient is accepted:
        • Need signed EMTALA
        • ED clerk will schedule BLS transport via Round Trip
        • MAC will arrange for ALS transport
        • HUMC RN will call RLA RN
  • General Exclusions for RLA
    • Acute Gastroenterology/Hepatology services need (acute GI bleeds)
    • Any cardiac issues deemed by cardiology team as likely needing invasive procedures such as Cath, CTS, or electrophysiology consult
    • Neurosurgical needs
    • Acute general surgery or ortho surgery needs (they have full podiatry services for DFI, etc.)
    • Acute Vascular surgery needs
    • Likely Oncology or urgent hematology needs
    • Patients being admitted solely for placements (can be placed if primarily admitted for medical need)