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 it 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)
  • 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 as 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 Policy 373.3 and agreement with USC CMO.
  • Sending facility (YOU) MUST ACCEPT PATIENT BACK ONCE STABILIZED by receiving facility at their request (per agreement with USC CMO).
• Ask MAC for estimated transport time
  • If the time frame for getting transport is inappropriate for the patient's emergency, ask to speak to the MAC MOD (Medical Officer on Duty) to discuss, or contact your Harbor AOD to request their involvement.

• • If transferring to USC and problems are occurring on USC end, ED Attending should try to resolve with USC accepting physician. If this does not work, call USC Medical Officer of the Day (MOD). Number available on http://amion.com Password distributed in email Feb 4, 2020 (Can't post on WikEM as this site is public)
• HLOC Transfer Sites
  • Replant Candidates Candidates
    • LAC+USC
    • 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

• Advanced Transport Options
  • Critical Care Ground Transport can be arranged through MAC - but may require 45 min or longer to activate
  • Aeromedical transport
    • ALS-level care
      • LA County Fire- -Air Captain number is 818-890-5755.
    • Critical Care Transfer
      • Private air ambulance - ask for critical care team.
        • Reach Medical: (800) 338-4045 or
        • Mercy Air: (800) 222-3456).
        • 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.
• Ask MAC to speak to the EMS Agency Administrator on Duty or Medical Director if quoted transport time unacceptable.
• Consider using our on campus ambulance, which is available until about 1130p (Code Assist EMT is not a paramedic, just EMT) +/- our own RN or MD with transport if indicated as a last resort.
• 911 (last resort). Takes the local unit of paramedics out of service for an extensive period of time.

(DHS Policy 373.3 v10-1-12)

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, placed in observation or CORE.
• 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/obs/CORE'd at HUMC.

See Also

• Harbor:Main
• Harbor:Transferring to psych ER