Transporting pts ER to ER

[lwems]

Okay, then followup question...

Suppose a patient wants transfer from one ER to another ER, not because he requires a higher level of care, but because he wants to be in a hospital closer to family, or to be in "the hospital that Reader's Digest says is the bestest", or whatever. And suppose dispatch accepts the call and assigns it to you.

You walk in and see the patient. And you know that insurance is NOT going to pay for the transport. The patient is going to get clobbered for the transport charge. And you can tell by his clothing that he can't afford a $1500 charge.

Do you try to warn him about this? Do you try to talk him out of it? Would you get in trouble if you persuade him to stay put?

On top of your concern for the patient's finances, what about the fact that your employer is probably going to get stiffed when they try to collect? Would that justify your behavior in your boss's eyes?

 

[mycrofft]

Okay, then followup question...

Suppose a patient wants transfer from one ER to another ER, not because he requires a higher level of care, but because he wants to be in a hospital closer to family, or to be in "the hospital that Reader's Digest says is the bestest", or whatever. And suppose dispatch accepts the call and assigns it to you.

You walk in and see the patient. And you know that insurance is NOT going to pay for the transport. The patient is going to get clobbered for the transport charge. And you can tell by his clothing that he can't afford a $1500 charge.

Do you try to warn him about this? Do you try to talk him out of it? Would you get in trouble if you persuade him to stay put?

On top of your concern for the patient's finances, what about the fact that your employer is probably going to get stiffed when they try to collect? Would that justify your behavior in your boss's eyes?

1. If it is not a burning emergency, call the boss.
2. If the pt gets rowdy, call Security.
3. If the ED gets impatient, move to a corridor nearby and call the boss.
4. If it is a case you cannot safely transfer, call the boss but don't physically move the patient onto your ambulance litter. If the boss says "Just do it" and you're pretty sure the pt will suffer, then it's time to pull up your big girl or boy pants and tactfully refuse; maybe ask a question like "If the pt is vomiting and crapping BRB, is very pale and going in and out of consciousness, and they couldn't start an IV, how would you suggest we treat this patient enroute?". Have a witness, log it and both sign it then make a copy. But if you are sure it will harm the pt, your responsibility is to say no.

 

[Handsome Robb]

Okay, then followup question...

Suppose a patient wants transfer from one ER to another ER, not because he requires a higher level of care, but because he wants to be in a hospital closer to family, or to be in "the hospital that Reader's Digest says is the bestest", or whatever. And suppose dispatch accepts the call and assigns it to you.

You walk in and see the patient. And you know that insurance is NOT going to pay for the transport. The patient is going to get clobbered for the transport charge. And you can tell by his clothing that he can't afford a $1500 charge.

Do you try to warn him about this? Do you try to talk him out of it? Would you get in trouble if you persuade him to stay put?

On top of your concern for the patient's finances, what about the fact that your employer is probably going to get stiffed when they try to collect? Would that justify your behavior in your boss's eyes?

We would never be dispatched to do the transfer unless he had already agreed to pay out of pocket, I'm not sure what kind of pre-approval goes into that.

It's not my job to judge whether someone is going to pay for their transport or not. It's not yours either.

 

[titmouse]

ER to ER is done for various reasons.

1. Most common, patient needs specialty care that is not offered at the current facility. Ortho, Trauma, Peds, Neuro what you may have.
2. If the patient needs admit and the hospital doesn't have a bed.
3. Health insurance purposes, A co-worker of mine's husband was in a car accident and her insurance was through a specific hospital health network he was shipped to the closest trauma center do to immediate life threats they performed surgery at that facility and once he was stabilized transported to the network that his insurance was part of. He was transported to the closest appropriate facility, he probably wouldn't have made it to the network hospital
4. Pt. request, if I pick you up and you possess a immediate life threat you use hospital B which is 45 minutes away, vs. hospital A which is 10 minutes away. Since hospital A offers enough services to provide you with stabilizing treatment and care to keep you alive. We go there. Then from there you may request to be transferred to Hospital B.

There's nothing wrong with ED to ED transport. as long as its performed within accordance of the standards.

+1 Could not have said better...

 

[ZombieEMT]

One thing that I do not see mentioned here, but maybe I missed, is the situation of a satellite ER. One of our local health systems has a satellite ER in a health center. Any patient requiring advanced testing or admitting, get transferred. The only medical floors to admit patient's to at the health center are hospice and/or mental health. The health center also provided radiology, dialysis and occ health.

Someone mentioned the patient's calling 911 from the ER, what about staff calling 911? We had the satellite ER once call 911 for an emergent transport to ER because scheduled transport had eta of 45+ minutes.

 

[usalsfyre]

Okay, then followup question...

Suppose a patient wants transfer from one ER to another ER, not because he requires a higher level of care, but because he wants to be in a hospital closer to family, or to be in "the hospital that Reader's Digest says is the bestest", or whatever. And suppose dispatch accepts the call and assigns it to you.

You walk in and see the patient. And you know that insurance is NOT going to pay for the transport. The patient is going to get clobbered for the transport charge. And you can tell by his clothing that he can't afford a $1500 charge.

Do you try to warn him about this? Do you try to talk him out of it? Would you get in trouble if you persuade him to stay put?

On top of your concern for the patient's finances, what about the fact that your employer is probably going to get stiffed when they try to collect? Would that justify your behavior in your boss's eyes?

I'm management at my company, so I have to worry about what pays the bills....but when I'm on the truck I don't consider it my problem. Do the transfer, then let someone else sort it out.

 

[cruiseforever]

With a free standing ER in our service area. There are multiple transfers a day with half to another ER.