Harbor:ED to Rancho Los Amigos (RLA)

ED to RLA (2/10/2026)
- Stable vs Unstable
  - If unstable for transfer, admit!
  - No ICU admissions from ED to RLA (HUMC ICU can consider lateral transfers)
- DHS Empaneled or DHS Eligible only
  - If OOP, goal is to transfer to in-plan hospital
  - Only OOP Exception - Kaiser: during Kaiser strike ONLY, place IQ request; once given authorization to admit after doc-to-doc conversation, place the "Consult to Transfer Center" order

- ED to RLA Admission Process
  - Patients 18 y/o and older
  - MONDAY - FRIDAY, 8am to 10pm (must place the "Consult to Transfer Center" during these times)
- 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/RLA PAC does their own financial clearance process and will inform us if there is no capacity for this level of care at RLA
    - RLA MOD/HOD (doctor on duty daytime/hospitalist on duty after-hours) 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 or ALS transport via Round Trip
      - MAC will connect HUMC RN with RLA RN once bed is assigned
    - If the patient is declined by the RLA MOD, contact UR for admission clearance at HUMC if not already MET
- 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)

Bradley Chappell, VC Clin Ops HUMC; Barry Jordan, CMO RLA; Michael Bolaris, ACMO RLA; Michael Scott, ACMO RLA; Peter Balingit, Medical Director MAC

Authors:

Bradley Chappell