Harbor: Hyperbaric Transfers
- Hyperbaric Transfer Options
- LBMMC (56x) 933-6960
- ED to ED transfers; LBMMC Transfer Center only handles inpatient-to-inpatient transfers
- HBO physicians are consultants and not admitting physicians.
- LBMMC (56x) 933-6960
6) The transfer center sees the question that the ED is addressing on transfer as to whether the ED has capacity to accept the patient to the ED. However, the ED (or at least the Attending that I spoke to, Dr. Milano) sees it as a question of hospital capacity. Thus, when he was asked by the ED Charge RN about the transfer, he asked her to contact bed control and check on ICU availability. Since there were no available inpatient ICU beds at that time, he refused the patient due to capacity. However, when I explained that the patient likely only needed SDU level of care, he asked the Charge RN to check again and on discovering that there was one available SDU bed accepted the patient for ED-to-ED transfer. A similar story unfolded simultaneously with UCLA, where the HBO physician endorsed the appropriateness for treatment but refused to serve as the accepting physician for transfer. The process for UCLA was aborted due to transfer acceptance to LBMMC.
Once the patient was accepted to LBMMC ED, a RoundTrip request was placed by Jesus the ED clerk, who contacted me (per my request) as soon as it was placed. I then contacted CDO to request expedited assignment of this request. I spoke to Robert, the CDO supervisor, who unfortunately informed me that there was a shortage of ALS ambulances at current time and the soonest we would be able to get an ALS ambulance was 5 hours, or 1 hour for a BLS ambulance if we thought we gather staff with a monitor to accompany the patient. The 3rd option was to request a 911-retriage. I spoke to Dr. Gupta, on-call physician for LACoFD, who approved the request. The patient was eventually transferred by 911 to LBMMC.
Suggestion for future process: 1) For emergent HLOC transfers for HBO, we should: 1) call the Hyperbarics physician at for “appropriateness” and then 2) call the LBMMC ED (number should be confirmed) to request to speak to an ED physician to request an ED-to-ED transfer. Provide the name of the HBO physician who has stated appropriateness. Be very specific about the anticipated level of inpatient care, your treatment time goal, and where the patient is in that timeframe (e.g. The patient is now 4 hours from removal from the environment and we think he would benefit form HBO treatment within the recommended 6 hours timeframe). 2) Involve UR only for transport if the patient has private (non-DHS) insurance. 3) Put through the RoundTrip request (through the AED clerk) for the desired transport level of care (all CO poisonings will need ALS at minimum). Ask the AED clerk to notify the Attending once the RoundTrip request has been completed. 4) Immediately call the CDO (at (866) 941-4401) to request that the RoundTrip be expedited as a time-critical illness. Explain that we want the patient to leave Harbor’s ED within 2 hours. If CDO anticipates that they will not be able to attain the requested transport level within that timeframe, discuss options for alternate transport. The primary option for alternate ALS is to request BLS and for Harbor to provide the transport monitor and staff (RN, MD) for the transport. For CritCare alternative, Harbor would request an ALS or BLS ambulance and provide (for ALS) an RN/MD and/or RT (depending on patient needs) with instruction to call Harbor base for Base physician orders if patient condition changes en route, or (for BLS) and RN/MD and/or RT with anticipated medications (advise taking the HERT meds box from the Trauma Pyxis and additional medications as necessary) and downtime order forms with instruction to call Harbor base for physician orders if necessary. 5) If no ambulances and/or staff are available to effect the transfer as per #4 above, consider 9-1-1-retriage request. Discuss with Harbor AOD and LACoFD/LAFD Medical Director(s) as appropriate.
Ideal is for patient to be in HBO chamber within 6 hours. However, 12-24 hours still has potential to improve outcomes.