Distance to Hospital

[Veneficus]

What's the cutoff, in your opinion (and others)?

I think there needs to be some reasonable judgement involved. I wouldn't put a time or distance rule into effect because so many variables have to be taken into account.

If the patient is having a complication of surgery, I think the best thing to do is take that pt. to the hospital the surgery was at. It is best for the patient.

If the patient is unstable, probably best to go to the closest facility that can help with the specific pathology.

If it will benefit the patient to go closer to family then they should go there.

If your system is extraordinarily busy, it may be best on a given day to take them to the closest and let the hospital sort the rest out.

I think the biggest issue in the case is recognizing what is best for the patient and doing it.

If they need/want to go somewhere outrageously far to your district, call them a private. Wait on scene till the private shows and then be on your merry way.

Unless the patient is truly about to die any minute according to reasonable and rational clinical judgement, not "what if..." Why does the 911 service have to transport? (aside from the billing, but that is the depatment's interest not the patient)

It is probably not a good idea to take the indigent people to the most expensive private facility because it is close. It just creates problems down the pipe, and while it is easy for EMS providers to claim that isn't thier problem, they probably wouldn't like it done to them. The same with people who have specific hospitals for their insurance.

It is foolish to think that system intergrity plays no role at all, but it doesn't always cause a complete breakdown to go out of your way in the interest of the patient to some degree.

Basically do all that is reasonably possible to help the patient. Don't just always do what is best for the providers.

 

[CAOX3]

I take them where they want to go," my doctors at this hospital", "my cousins sisters brothers nieces's mother died at that hospital so I can't go there". If their not critical I'll take them where they want to go, where not going ob a road trip, within reason.

 

[JPINFV]

Something else to think about. There's always that one hospital in your area that you wouldn't be caught dead in if you had the choice (anyone remember King Drew Medical Center?). Would you want to be on a gurney being told that you had to go to that medical center for no reason other than distance?

 

[ZombieEMT]

In our department, we transport to the closest facility when the patient is not stable enough to make it to the hospital of their choice. When we have a stable patient, they make the choice. Other considerations are hospital specialties. Unless the patient is coding we take a trauma twenty minutes to the trauma center. However, our department is lucky. We have three hospitals which about the same distance to our department and the patient almost always chooses one of the three.

 

[johnrsemt]

Sometimes it is due to what the patients insurance will pay: if they are not critical; Insurance A will pay 90% of in network hospitals, and only 50% of out of network hospitals. Even for the ED that can be $5,000 difference in out of pocket expense.

 

[Bullets]

This is easy, pt says i want to go to some other place, my reply is "No, we have a level II trauma center, stroke center and cardiac center in town" Max transport form anywhere in my town is 5-7 minutes, and its the best hospital in the county. next closest is 15 which has a great L&D, then 2 20 minutes, one is scary, the other has a good L&D, and then one 30, which i would rather die then go to.

Is there anything they will do at other hospital that they cant do just as well at Generic University Medical Center?

 

[usalsfyre]

Is there anything they will do at other hospital that they cant do just as well at Generic University Medical Center?

Be covered by a patient's insurance.

Be seen by a physician (after admission) with whom the patient has a prior relationship.

Not be seen by residents (not saying it's right, just saying it plays into people's decisions).

 

[abckidsmom]

This is easy, pt says i want to go to some other place, my reply is "No, we have a level II trauma center, stroke center and cardiac center in town" Max transport form anywhere in my town is 5-7 minutes, and its the best hospital in the county. next closest is 15 which has a great L&D, then 2 20 minutes, one is scary, the other has a good L&D, and then one 30, which i would rather die then go to.

Is there anything they will do at other hospital that they cant do just as well at Generic University Medical Center?

And our crappiest hospital has the best urologist ever. I am even willing to deal with riding herd on the nursing staff in order for my dad to see his urologist.

The patient's preference definitely comes into play when you are considering which facility is appropriate.

 

[Bullets]

Be covered by a patient's insurance.

Be seen by a physician (after admission) with whom the patient has a prior relationship.

Not be seen by residents (not saying it's right, just saying it plays into people's decisions).

as a non billing agency, insurance rarely is mentioned on our calls for service

how often do you have to go to the hospital to be familiar with the various doctors there? if its an emergency, your GP wont be there for a while

 

[JPINFV]

as a non billing agency, insurance rarely is mentioned on our calls for service

Just because you don't know what hospitals the patient's insurance covers doesn't mean that the patient doesn't know what hospitals his insurance covers.

how often do you have to go to the hospital to be familiar with the various doctors there? if its an emergency, your GP wont be there for a while

You should go to a hospital with doctors that you are familiar with anytime you need intensive specialty care (e.g. LVADs), had recent major procedures or hospitalization, or when ever you expect you will need to be admitted. Sure, the PMD isn't going to be there when you arrive, but that doesn't mean that the PMD won't be the admitting physician for your patient. Most emergency medicine physicians do not have admission privileges.

 

[Veneficus]

This is easy, pt says i want to go to some other place, my reply is "No, we have a level II trauma center, stroke center and cardiac center in town" Max transport form anywhere in my town is 5-7 minutes, and its the best hospital in the county. next closest is 15 which has a great L&D, then 2 20 minutes, one is scary, the other has a good L&D, and then one 30, which i would rather die then go to.

Is there anything they will do at other hospital that they cant do just as well at Generic University Medical Center?

Re operate.

Because the landmarks and anatomy are often totally unrecognizable, it really helps if the person who did it originally goes back, rather than a new person trying to figure it out as they go.

That applies to any surgical discipline, including OB/GYN.