We deal with about 20 hospitals, owned by about 7 different HMO's. We have 3 level I trauma center, 2 peds level 1s, outstanding neuro and cardiac services widespread (10 cath lab options), but we still run into the same issues.
My hospital is a public safety net hospital that does pretty much everything, and does it exceptionally well. Our management asks that we bring 40% of our patients back to our hospital, which isnt really that hard, and 95% of the time, the patient gets taken to their facility of choice. I bring patients to my hospital knowing that although, i may have to clean a bed or two, my patient will have all of the services they could need, easily accessable and they will be cared for in an often utilitarian, but decent way and the nurses, residents, physicians, ultrasonographers, techs, HUCs, and environmental services folks all have one mission in mind, the care of our patients. Of the hospitals we have access to, there are only 4 that i consistently enjoy taking patients to, and maybe 6 others that i dont regard as pre-mourge-ish.
Hospitals have tried multiple dirty tactics such as appealing to our job and trying to lure us with food (one hospital bought a slushee machine). At the end of the day, there is still one fundamental problem with some of these hospitals, they dont do as good of a job caring for the patients that we bring them. Sometimes it is being placed in a mental health room, despite advising them that the patient is suffering from an acute CVA, or sometimes it is as simple as the hospital staff just omitting our presence and just listening to the patienta and not our account of the evolution of the patients EMS course.
When hospital complain to our counties advisory board about us bypassing their facility, we are completely upfront about why we didnt go to their facilities, and have the data showing if it was the patients facility choice, the paramedics facility choice, a physician decision or a hospital divert. Much like when you must preclude a patients facility choice, you need to be prepared to explain what services they cannot receive at their facility of choice, that they will have access to at the alternate hospital.
At the end of the day, the things that annoy me the most are not incidental things, but generally a poor culture among the hospitals staff that doesnt always put the patient first.
