Transfer of Care: RE Dialysis PTs

[VA Transport EMT]

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.

 

[Kevinf]

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.

 

[MMiz]

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.

 

[ANDREWG]

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.

 

[Tigger]

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.

 

[Aidey]

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.

 

[VA Transport EMT]

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?

 

[Fish]

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.

 

[Jon]

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.

 

[VA Transport EMT]

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.

 

[Fish]

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

 

[VA Transport EMT]

can't call FD for every lift assist.

 

[NomadicMedic]

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.

 

[Jon]

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.

 

[Ewok Jerky]

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.

 

[Tigger]

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.

 

[medicdan]

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

 

[Ace 227]

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.

 

[Angel]

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

 

[VA Transport EMT]

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.