Night Transfers?

[lightsandsirens5]

A good article in my opinion. What do you all think?

http://jems.com/article/patient-care/think-you-transfer


Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.

 

[ParamedicEd]

Great Article!

Night transfers that are not emergencies are overwhelming, unnecessary and in my eyes medicare fraud most of the time. "Why is this person being transported by ambulance?", "Because their kids are away, wife is sleeping and our policies won't let us call them a taxi to get home," and my personal favorite, "Because chaircars don't run at night." Too often do we see these situations while working overnights. The same goes for psych patients being transferred out to a physchiatric hospital at 4am because they just got accepted, or in most cases because the case working at the ED finally finished the paper work. Who is to blame here? The ED for trying to clear the emergency rooms or the private ambulance company who actually accepts the call? A rule needs to be made where discharges (who are completely stable) should not be transferred out until, lets say 7 a.m. Don't get me wrong when I work the 911 system and get call after call at night it does get nauseating but still, you put on your Medic face, suck it up and do what you have to do. These people are calling 911 for an emergency and are not a medical professional asking for a ride simply because we were the only people around (well for the most part anyways). Great article showing the frustration on this subject that many others are frustrated with but no means or attempt to change the problem.

Jeremy Cerce
BA EMT-P

 

[adamjh3]

I think both non-emergent night transfers AND 24 hour shifts are ridiculous.

My company contracts with an adolescent psych facility, at least once a night we get woken up for a transfer from there. I'm not going to whine too much about getting woken up as it's the job and that's what I get paid for. However, we often get there (say it's the beautiful 0300 call) the kid's wrapped up all cozy in a bed sleeping, we wake him up and find out he's there because he's depressed and suicidal for whatever reason (often crappy or abusive relatives) and just wanted to get away for a while. So we put him on the uncomfortable gurney, drive him 30 minutes in the back of an ambulance on bumpy San Diego roads (in 4pt velcro restraints if you follow company policy [no comment on that one] ) wait outside in the cold of night for the nurse to come out and unlock the door, then go inside and have the nurse talk to him like he's three years old. Then while we're finally leaving he's just starting his game of 20 (or 100) questions with the Nurse.

Why does this have to be done at 0300? He was sleeping for Chrissake, he's not in immediate danger from himself, he's not a danger to anyone else. He's not having an active episode of SI. Why, why, why?

 

[lightsandsirens5]

I agree. It is rather frustrating. This article was brought to my attention the other day by a partner while sitting at the station during a day shift. Two nights prior, I was filling in for someone else, and was with a gal who is not my usual partner. Well, we were tasked at 2100 for a 4 hour, non emergent IFT. Upon calling back in service, we went to the station, restocked the rig and headed off to bed. No sooner did my head hit the pillow then the pager goes off again. Another IFT. Another 4 hour IFT. From the same sending hospital. To the same receiving hospital. Again, non emergent. To add insult to injury we show up at the ER and get told: "She isn't quite ready to go. You'll have to wait 45 minutes till we get all the paperwork done and send report. We just wanted to call you out so we could be sure of getting a crew.

Needless to say, driving that last call was painful. It was a struggle to keep my eyes open after the first 50 miles or so. I seriously considered telling my partner we were going to have a "breakdown" and pull over to wait for another ambulance to finish the call. Ha ha!

Both transfers all because the floor said they didn't want any more patients or they would have to call in their on call aide.
So to save paying a NAC, they sent me on two calls that put my and my partner and both patients at increased risk.

Yes it's my job, but there is a difference between running a couple of half hour calls in town and during which, you pretty much keep moving and can easily stay awake the whole time. It's another thing to get sent on back to back 4 hour IFTs starting at 2100. :-S


Sent from a small, handheld electronic device that somehow manages to consume vast amounts of my time. Also know as a smart phone.

 

[usalsfyre]

Clearing the ED beds is the only reason. Which is important, but blows monkey equipment if your company works 24s.

Equally frustrating are the "higher level of care" transfers to say, the children's hospital 150 miles away for "possible meningitis" on a five year old who's running around his room because the ED physician didn't want to deal with tapping the kid.

 

[coastiewifejenna]

Transfers

I think that if the transfer is for a non-emergent reason, then it should have to wait til the day time. No questions asked.

 

[NomadicMedic]

I did more than my share of those 0200 BLS/IFT transfers.

They're dangerous for the crews and patients.

Just one more reason I chose to work for a 911 only/non transport/ALS only agency. Oh yeah, we only work 12 hour shifts.

 

[MMiz]

Working the 7p-7a shift as the only BLS unit I was often used as a taxi to clear EDs. When you have four back to back calls from the same facility a county over it's pretty much guaranteed they're cleaning house.

Emergency medicine is 24/7, and sadly they only get to the psych patients and head colds after treating everyone else.

It made for a long night sometimes. My partners who worked 24s shouldn't have been working, but they had to pay the bills and there was no regulation or company policies about working 24s. Good times.

 

[Sasha]

The same goes for psych patients being transferred out to a physchiatric hospital at 4am because they just got accepted, or in most cases because the case working at the ED finally finished the paper work.

Why wouldn't they transfer them when they got accepted? at least here, the psych hold starts from the minute they are medically clear. They are not going to get the care they need in the ER, so time is of the essence. At least at the psych facility they can get intake done and evaluations started even before the doctor gets there.

 

[Aidey]

The only night transfers that really bother me are the "there isn't a wheelchair van available" ones for people who are perfectly able to walk or sit in a WC. There is is WC van available 24/7, but it is Medicare/medicaid only, which coincidentally 98% of those patients are. It also annoys me when the patient's family refuses to transport the patient when the patient is capable of being transported in a private vehicle.*

I can understand transfers happening in the middle of the night because a bed just became available at the receiving facility. I'll admit to do wonder why on earth a bed opened up at the pysch hospital at 2am, but whatever...


* We did a 100ish mile transport of a hospice patient who was so annoying the pts two daughters were willing to pay the $2000 bill out of pocket in order to avoid sitting in the car with the patient for the whole drive. We got handed fresh baked (still warm!) chocolate chip cookies as we left with a lot of thank yous. I can't say I blame the daughters...

 

[Sasha]

I'll admit to do wonder why on earth a bed opened up at the pysch hospital at 2am, but whatever...

That's probably when their last psych pt's psych hold expired.