# Transfer of Care: RE Dialysis PTs



## VA Transport EMT (Dec 23, 2012)

Recently my transport company has been having problems with Dialysis staff regarding the responsibilities to our PTs. To my, and my co-workers, the PT is the responsibility of the center until they are on our stretcher but the Dialysis staff thinks otherwise.

1. The staff refuses to help lift a PT to our stretcher (she is a regular PT and recently had surgery on her leg and it can't be bent or else the PT has severe pain) and state it is against their policy to touch PTs.

Wouldn't this be considered abandonment since the PT isn't our responsibility yet? If they aren't allowed to touch the PT, how are they supposed to do dialysis?

2. The staff refuses to weigh each PT, again in their list of duties for each PT. Most of the dialysis centers' scales aren't big enough for our stretchers. Our stretchers come out in different weights on every scale we go to, usually range from 40kg to 49kg; but this isn't really a big issue since we need to get the PT back to their residence.

Weight isn't a big issue since it's required for the PT's treatments; but it would be nice if the staff would be a little bit more co-operative.

My co-workers and I do everything in order to accomodate the circumstances and make the trip comfortable for our PT but it's gotten to the point where the staff makes comments that make the PT feel like their bothering the staff. In order to move some of our PTs we need a staff member to assist us with the legs and feet so they don't drag and displace the stretcher. I feel as if we might drop the PT or cause unnecessary pain to the PT.


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## Kevinf (Dec 23, 2012)

No they don't have to help you, as it is not their equipment the patient is being transferred to. Also, by the time you are moving the PT to the stretcher you should have gotten a patient release signed so they are your responsibility (why would you move a patient that hasn't been signed over to your care yet?) If you can't move the patient safely or without injury (to the PT or yourselves) you should call your dispatch for a lift-assist. FMC is our local dialysis center, and their scales accommodate the geri-chair the patient sits in. The weight is always marked in the patient chart.


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## MMiz (Dec 23, 2012)

This isn't what you want to hear, but of the many dialysis centers I've served, it was clear that I was responsible for patient transfers.  If you need help lifting you should call dispatch for a lift assist. 

We were also responsible for weighing the patient, though it was always done on the stretcher. 

Transport patient, arrive at dialysis, provide any paperwork, weigh patient on stretcher, transfer patient to chair, make them comfortable, check in again with dialysis staff, weigh stretcher again, provide numbers to dialysis staff, on to the next one. 

I, like many providers, faced a wake up call when I realized how important fitness and strength were to the profession.


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## ANDREWG (Dec 23, 2012)

Wow, our dialysis center we go to are a lot friendlier apparently. We never have to weigh our patients. The staff helps with anything we need. I guess we have it good around here.


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## Tigger (Dec 23, 2012)

I think it is a little ridiculous that the staff can't spare a second to lift someone's legs to make extra sure that they won't be hurt. However, any transfer to or from the ambulance stretcher is the ambulance crew's responsibility. When you get to the hospital do you just step back and let the ED staff put them on the bed? No, of course not. And for me personally, if possible I like to have only other EMS crews help with bed to bed transfers simply because they are likely to be more familiar with that dynamic, especially at dialysis where the staff just doesn't do them all that often.

As for weighing the patients, I think that responsibility should fall on the dialysis center as we do not need to document that information and weighing is part of the center's patient care. However I still do it just to minimize fuss.


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## Aidey (Dec 23, 2012)

I used to work in a dialysis clinic. Our policy was basically no lifting. We were allowed to help stabilize pts while they stood and and pivoted or use a hoyer, and that was it.


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## VA Transport EMT (Dec 23, 2012)

It's not about what I want to hear but since this is my first transport job I was looking for advice.

Now that you mention it, I don't make the ED do all the work.

@Aidey:
if you weren't allowed to lift, would you be able to stabilize the extremity while the emt's lift the PT via sheet?


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## Fish (Dec 24, 2012)

I think I would remind the staff that this patient is both of ours, just because we are here doesn't mean that their role ends. There is a common goal, get the patient to and from dialysis safely.


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## Jon (Dec 24, 2012)

Many places have a "no lift" rule - it's designed to keep insurance down, etc. I've seen various nursing homes and clinics with the same rules.

Weight is incredibly important for dialysis - personally, I don't understand why it's EMS's job to weigh the patient, though.


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## VA Transport EMT (Dec 24, 2012)

thanks everyone for clearing it up. lift assists aren't available due to tight scheduling, if we need a lift assist it's at least one hour wait in addition to transport time.


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## Fish (Dec 24, 2012)

VA Transport EMT said:


> thanks everyone for clearing it up. lift assists aren't available due to tight scheduling, if we need a lift assist it's at least one hour wait in addition to transport time.



Local FD can be called for lift assist


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## VA Transport EMT (Dec 25, 2012)

can't call FD for every lift assist.


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## NomadicMedic (Dec 25, 2012)

VA Transport EMT said:


> can't call FD for every lift assist.



Sure you can. They'll just stop coming after the 3rd or 4th trip over to the old dialysis center.


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## Jon (Dec 25, 2012)

VA Transport EMT said:


> thanks everyone for clearing it up. lift assists aren't available due to tight scheduling, if we need a lift assist it's at least one hour wait in addition to transport time.



Guess what. They can and will schedule one if it's truly important.


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## Ewok Jerky (Dec 25, 2012)

Fish said:


> Local FD can be called for lift assist



I have before and I will again tell my dispatch that I am not making a lift without an assist, either from another crew, fire, or another ambu company. THIS Pt is not worth ruining my back for. I also have my safety "officer"'s # on speed dial for these type of situations.

Lifting is a BIG  part of this job and back injuries are the #1 reason for going out on disability so its important that you take care of your back.


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## Tigger (Dec 26, 2012)

VA Transport EMT said:


> thanks everyone for clearing it up. lift assists aren't available due to tight scheduling, if we need a lift assist it's at least one hour wait in addition to transport time.



Sounds like they need to schedule another truck to go with you then. I'll help other crews at the dialysis center with their heavy patient (and hope for the favor to be returnees), but sometimes I wonder what they'll do at the other end. I will say that getting someone out of dialysis chair and onto the stretcher is one of the tougher moves around if the chair sides don't open.


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## medicdan (Dec 26, 2012)

See if any of this advice speaks to you... Or helps
http://www.emtlife.com/showthread.php?t=14323


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## Ace 227 (Dec 26, 2012)

We do plenty of dialysis trips and for every one we do the weighing and the moving.  We have a good relationship with the dialysis centers for the most part and this was just seen as part of the job.  

On the other hand, for particularly heavy pts, they will help move the feet typically.  Sometimes not though. Its not a huge part of my job so when we do have a less than cooperative staff member I usually don't dwell on it.


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## Angel (Dec 28, 2012)

My company has mandatory lift assist for any pt >300lbs and I personally dont care how long it takes I refuse to get injured lifting a pt because they told me a 1 hr ETA. Quite frankly they can either adjust scheduling or have us delayed on this call (unable to run other calls) while we wait. Why? Because if I get injured it becomes MY fault for going against company policy and its just not worth it to me. 

I also despise having to move patients over and over again because whoever designed these facilities put a scale right next to a wall but it just has to be done. Luckily I havent had too many this bid


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## VA Transport EMT (Dec 28, 2012)

Thanks everyone for the replies, a few of us have submitted suggestions to our boss and hopefully we'll see some improvements in the future! Have a happy new years everyone.

@dan
thanks for the thread, I hope to use these on Monday when I work again.


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## exodus (Dec 30, 2012)

For the weighing, push the chair they're in to the scale and use those.  And the no lifting rule usually isn't the staff's fault, it's the policy of the centre.  I know if I worked at one, and that was the rule, I wouldn't push my luck with it. That's my livelihood.


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## leoemt (Jan 1, 2013)

I have never had them refuse to lift assist a patient - infact I have had them yell at us because they wanted to be a part of the lift. In the rare instance where noone was available they have provided us a hoyer (sp?) lift to use.

Weighing patients is the responsibility of the center. Though some centers have us weigh them on the stretcher. 

Dialysis centers use us based on contracts. Our company makes sure that it is written into the contract for lift assists when necessary.


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## MidTech (Jan 3, 2013)

Negative!!  It is not the EMT's responsibility to weigh _their_ pt's. It is a _kindness_. However, my company has one of our biggest contracts with a dialysis center located inside a hospital with our biggest contract.  Therefore we have a supervisor that works inside the dialysis ctr to oversee our smooth work and transition of care....therefore we are *expected* to be _kind_ here!

But it is necessary, at times, to remind these rude dialysis techs that it is a kindness and not our job to weigh them.


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## Aidey (Jan 3, 2013)

Actually, for some services it may be a condition of their contact that they weigh the patients.


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## Medic Tim (Jan 3, 2013)

MidTech said:


> Negative!!  It is not the EMT's responsibility to weigh _their_ pt's. It is a _kindness_. However, my company has one of our biggest contracts with a dialysis center located inside a hospital with our biggest contract.  Therefore we have a supervisor that works inside the dialysis ctr to oversee our smooth work and transition of care....therefore we are *expected* to be _kind_ here!
> 
> But it is necessary, at times, to remind these rude dialysis techs that it is a kindness and not our job to weigh them.



It actually is for some services. Contracts and whatnot.


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## Akulahawk (Jan 3, 2013)

Most of the dialysis centers that I have transported patients too, have been responsible for weighing their own patients. That is just simply how our contracts were written. If the contract required that the crew weigh the patient, I would certainly ensure that the crew understood that weighing the patient was part of their responsibility and also ensure that they knew how to do it. The other thing that I would expect from the facility end is that they'd instruct the crew in how to weigh the patient, using the facility's equipment, if the contract specified that the transport crew weighed the patient. 

From a facility standpoint, I'd want to ensure that each patient is accurately weighed before and after therapy, using a standard procedure, and ensure that procedure is followed, regardless of who does the weighing. Ensuring that policy is followed would help minimize liability that could fall back on the facility. 

No matter what, always be kind to the personnel at the various facilities you transport to or from. Because of crew attitudes, a company can gain or lose contracts. Since all transport companies can pretty much provide the same levels of service, it can very easily come to perceived crew attitudes. Lose enough transport contracts and you can kiss your employer bye-bye.


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## ZombieEMT (Jan 4, 2013)

When working transport, I never had an issue with staff refusing to lift a patient but it was rare that we requested it. I actually perferred that they didn't. Once we touch our patient care is transferred. Additionally most staff at dialysis centers are not allowed or trained in lifting. If its a recurring issue with the same patients something should be worked out for assistance, whether a third crew member or additional truck. If the issue is with most of your dialysis patients, the problems appears it might be the operator.


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## MidTech (Jan 8, 2013)

:rofl: You'll notice that in most cases your contracts are with the Nursing Homes and their dialysis pt's are your companies responsibility for transport. Your contracts will not be with the dialysis center.  Ambulance contracts will ensure some sort of BLS/ALS routine transport of pt's to these dialysis facilities along with the transfer of care.  

Though, it really is *not* our job to weigh the dialysis pt's, we do it out of kindness.


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## MidTech (Jan 8, 2013)

Oh, and if your company picks up a pt out of a NH in which your company does not have a contract, this doesn't mean your contract is with the dialysis ctr but rather with the pt's insurance.


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