Transporting pts ER to ER

leeksoldier

leeksoldier

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Hello all,
I have looked this up and can't find anything on Google or emtlife.
My question is, in Texas, or anywhere, is it legal to transport a patient from one ER to another? Obviously I'm talking about a transport service.
Thank you for your time.
 
ER to ER transports are frequent in the EMS agency.
 
leeksoldier said:
Hello all,
I have looked this up and can't find anything on Google or emtlife.
My question is, in Texas, or anywhere, is it legal to transport a patient from one ER to another? Obviously I'm talking about a transport service.
Thank you for your time.
Click to expand...
ER to ER transports are done all the time... and are done in accordance with EMTALA, and coordinated in a similar manner as an ICU to ICU transfer. In order to keep that patient from taking up an ER bed, I'd rather do an ER to Floor/Unit transfer, but that's just me. :blink:
 
ER to ER transports are extremely common. They are most common from smaller hospitals to larger ones. The reason being, smaller hospitals often do not have the specialty services (Trauma, neuro, GI, cardiology, cath lab, pediatrics, and the list goes on.) If the patient is in the ER at a smaller, less capable facility, oftentimes they start out in the ER at the receiving facility to have more extensive testing and assessment done. As long as it is done in accordance with EMTALA, then everyone is in the clear. Hospitals that do transfer patient's have their own internal documentation to make sure EMTALA is followed. For example, in my system there is an EMTALA transfer log where it is documented the reason for transfer as well as what steps were taken to transfer the patient and what facilities were called. Sometimes, if the transfer is emergent enough and can not wait for a scheduled transfer, many hospitals use the 911 system.
 
It is legal. The transporting hospital only has the legal obligation to ensure the pt is stabilized.
 
Thank you all so much for the replies. I was feeling uncomfortable about it.
 
I've done quite a few ER-ER trips from a level 2 to a level 1, or to a specialty center ER.
We have had issues with regulars calling 911, being sent out to triage, and recalling 911 again for transport to another ER because they didn't like being sent to triage, that usually ends up with them going to the county hotel instead of the other ER though.:P
 
I've also done ER to ER transports for insurance reasons. For example, someone gets hurt, calls 911, and is taken to the most accessible receiving facility. Problem is is that that hospital isn't in your insurance network. Sure your insurance will most likely cover the emergency treatment and care, but if you need to be admitted, get surgery, or any other specialty care, especially once you're stabilized, you'll get transferred to your home hospital. Sometimes you'll have a room on the floor, other hospitals will hav3 you go through their ER to be reevaluated before being admitted.
 
wannabeHFD said:
It is legal. The transporting hospital only has the legal obligation to ensure the pt is stabilized.
Click to expand...

What if the original receiving hospital can't stabilize them? Sounds like a medical tar pit to me; one toe in, and you are stuck.
 
ER to ER is done for various reasons.

1. Most common, patient needs specialty care that is not offered at the current facility. Ortho, Trauma, Peds, Neuro what you may have.
2. If the patient needs admit and the hospital doesn't have a bed.
3. Health insurance purposes, A co-worker of mine's husband was in a car accident and her insurance was through a specific hospital health network he was shipped to the closest trauma center do to immediate life threats they performed surgery at that facility and once he was stabilized transported to the network that his insurance was part of. He was transported to the closest appropriate facility, he probably wouldn't have made it to the network hospital
4. Pt. request, if I pick you up and you possess a immediate life threat you use hospital B which is 45 minutes away, vs. hospital A which is 10 minutes away. Since hospital A offers enough services to provide you with stabilizing treatment and care to keep you alive. We go there. Then from there you may request to be transferred to Hospital B.

There's nothing wrong with ED to ED transport. as long as its performed within accordance of the standards.
 
Another common reason is that the original ED might not be staffed with residency trained EPs and the patient might need a procedure done that the community/rural ED might not be comfortable doing (i.e. draining peritonsilar abscesses).
 
wannabeHFD said:
It is legal. The transporting hospital only has the legal obligation to ensure the pt is stabilized.
Click to expand...

Actually, stabilized to the best of the transferring hospital's ability. A trauma patient at a non-trauma center isn't going to be completely "stabilized" prior to transport if the patient needs surgery. Same thing with the STEMI who needs a cath lab.
 
How about if a patient says "this ER didn't give me what I want, take me to another"...
 
leeksoldier said:
How about if a patient says "this ER didn't give me what I want, take me to another"...
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From a EMS standpoint if the Sending Doc and Receiving Doc approved the transfer than its out of your hands.

Most likely if the patients health care insurance decided that the patient could have received appropriate interventions at the facility they were initially at they will most likely be faced with the transport bill.

there is a handful of patients that hospital shop since they believe that another hospital is going to give them "what they want" or a diagnosis that they want to hear.
 
We have patients who call 911 from inside the ER. Dispatch will tell them we will not be responding. And then calls the ER.

If the ER sets up the transfer than all is good to go.
 
Anjel said:
We have patients who call 911 from inside the ER. Dispatch will tell them we will not be responding. And then calls the ER.

If the ER sets up the transfer than all is good to go.
Click to expand...

I'd kill to hear one of those calls.

911 Where is your emergency?
Caller - I'm in ABC Hospital Emergency Dept. They aren't giving me what I want. I am in pain can you get an ambulance to take me to another hospital?
 
Did one a few days ago from a small rural hospital ER (in TX) to a level 2 trauma center ER with a pt who had an active brain bleed. The transfer was technically ED to ED because the pt did not have a bed at the receiving facility, so they just admitted him to the ED. The pt needed neurosurgey - which was not in the capabilities of the small hospital he was initially transported to.
 
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If patient is in an ER somewhere than usually it'll be an ER-to-ER transfer. If they were already admitted and an inpatient than it's usually an ICU-to-ICU (or floor to floor) transfer.

Absolutely normal and legal assuming EMTALA criteria is met. We get these frequently with STEMI patients and intracranial bleeds.
 
~Cough~KAISER~Cough
 
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