Harbor:ED to Rancho Los Amigos (RLA)

ED to RLA (2/4/2026)
- 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
  - 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)

Authors:

Bradley Chappell