Harbor:Transferring a patient

Transferring patients out for HLOC - Time Sensitive Life/Limb/Permanent Disability Threatening Conditions

• If Transferring to another DHS Facility that offers needed service:
  • Call Medical Alert Center (MAC) and state "This is a Higher Level of Care Emergent/Urgent transfer under DHS Policy 373.3" File:ELTC HLOC Urgent Emergent Transfer DHS 373.3 Policy.pdf AND make clear the time frame in which you need that patient to get definitive care
  • MAC should get transfer approved within 60 min to appropriate DHS facility
  • If any resistance from receiving facility immediately have ATTENDING to ATTENDING discussion (through MAC, as calls are recorded).
  • Sending physician (YOU) has right to make final decision about sending for an evaluation. The receiving physician can decide what therapy to give the patient, but so long as they have the appropriate PERSONNEL and EQUIPMENT, they must accept the patient for evaluation if you request it. (Per DHS Policy and EMTALA Law)
  • Receiving facility CANNOT DECLINE DUE TO LACK OF BEDS, under DHS Policy 373.3
    • • If transferring to LAC+USC and problems are occurring on USC end, ED Attending should try to resolve with USC accepting attending physician. If this does not work, call USC Medical Officer of the Day (MOD).
  • Sending facility (YOU) MUST ACCEPT PATIENT BACK ONCE STABILIZED by receiving facility at their request (per agreement with LAC+USC CMO).
    • • If LAC+USC specialty service states no further care needed there, accept back at Harbor ED to complete care.
      • If you are dealing with a complex case, please elevate such calls to our EMS AOD, or UM MOD (Peter Balingit) so they can provide direction to MAC and Transfer Center UM regarding management.

• Once accepted, ask MAC for estimated transport time
  • If the time frame for getting transport is inappropriately long for the patient's emergency, ask to speak to the MAC MOD to discuss, or contact your Harbor DEM AOD to request their involvement.
  • If MAC has no ambulances, MAC may decide to use 911 Emergency Trauma Re-Triage as last resort. Avoid if possible as it takes the local unit of paramedics out of their response area for an extensive period of time. But you can suggest this to MAC if you feel it truly indicated
• Advanced Transport Options - MAC can arrange ALS or Critical Care Ground or Air Transport if transferring to a DHS facility
  • May require 45 min or longer to activate
  • If transferring to a non DHS facility, ask the accepting facility if they can send air transport if you feel it is needed.
• Consider sending RN, MD or RT staff with LA County fire when CCT level of air ambulance transport is required and private CCT is unavailable or the ETA is too long.

• HLOC Transfer Sites
  • Replant Candidates Candidates
    • LAC+USC, see Harbor:Replantation_Patients for details on transfer process
    • UCLA Westwood
  • Burns
    • LAC+USC
    • Torrance Memorial
  • STEMI if our cath lab is encumbered: 911 to closest STEMI Receiving Facility. MICN - has what SRCs are open, courtesy call to their ED
    • STEMI 911 Inter-Facility Transfer (IFT) during cath lab remodel
  • Stroke patient to Comprehensive Stroke Center - not through MAC. Harbor:Transfer_to_Comprehensive_Stroke_Center
  • Patient needing emergent radiation therapy - through MAC, rare, but patient goes to LAC+USC Harbor:XRT
  • Hyperbaric Treatment for Carbon Monoxide Toxicity
    • Options - UCLA Westwood, Long Beach Memorial, UCSD, NOT MAC to Catalina (only for dive injuries)
    • UR coordinates the acceptance
    • Transfers: UR should help coordinate the transfer - ELTC/HLOC - needs to occur <1-2 hrs
      • Sending facility is supposed to arrange transfer
      • If UR not able to get transfer in a timely manner --> MAC (CDO) - must be approved by house supervisor & Joy; BLS/ALS/CC transport
        • Medics can call the radio for online base medical direction/orders

Transfers out to Out of Plan (OOP) patient's health network

• Any OOP patients who are deemed stable for transfer, should have Interqual request placed to see if Utilization Review (UR) staff can transfer the patient back to a hospital in the patient's insurance network.
• Applies for patients who would otherwise be admitted
• If UR is unable to contact the health plan, or unable to find a bed in a timely fashion (up to attending discretion considering status of ED), then the patient can be admitted at HUMC.

See Also

• Harbor:Main
• Harbor:Transferring to psych ER