# ER discharge situation



## Brandisii (Jul 23, 2017)

ER discharge.  Receiving facility does not want to receive returning patient because patient's vitals are not within normal limits even though the MD has discharged and cleared them medically.  To transport or not...  and if I transport...  how do I convince the receiving facility that they have to take back their patient...  unless they don't have to?  This is for Los Angeles County, btw.  Thanks!


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## DrParasite (Jul 23, 2017)

Hospital needs to make sure recieving facility will accept patient, not the responsibility of ambulance crew.  Not my problem.

If I think the recieving facility will not accept the patient, contact a supervisor before you leave the sending facility


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## Akulahawk (Jul 23, 2017)

Brandisii said:


> ER discharge.  Receiving facility does not want to receive returning patient because patient's vitals are not within normal limits even though the MD has discharged and cleared them medically.  To transport or not...  and if I transport...  how do I convince the receiving facility that they have to take back their patient...  unless they don't have to?  This is for Los Angeles County, btw.  Thanks!





DrParasite said:


> *Hospital needs to make sure receiving facility will accept patient*, not the responsibility of ambulance crew.  Not my problem.
> 
> If I think the receiving facility will not accept the patient, contact a supervisor before you leave the sending facility


This is pretty much the reason why there's a nurse-nurse report done prior to transport. The receiving facility is provided information about the patient, including current vital signs. Generally speaking the ED will not discharge a patient that's going to another medical facility without that facility first accepting the patient. I'm an ED nurse and I must have acceptance from that other facility before the transport/transfer is initiated. As part of this process, I will document the name of the person I gave report to and this will be part of the medical record of that patient at my facility. I also advise the transport crew who that receiving nurse is. If the receiving facility rejects the patient after this point, you find out who rejected the patient, and then you return to the sending facility and provide info as to why the patient was refused. While the sending facility hates to receive a patient that was just discharged (and because they do hate this) they'll also try to find out why the patient was refused and if nothing has changed since the discharge report, complaints will be filed. 

The acceptance process prior to arranging transport can often be one of the longest phases of the discharge/transfer process.


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