Interfacility Transfers

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" height=82 style=" border-bottom: 1px solid #999980;" BGCOLOR="#CCFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Roscommon Township</B></FONT><FONT SIZE="2" COLOR="#000000" FACE="Times New Roman" ><B>   </B><B>|</B><B>     </B></FONT><A HREF="index.htm" TARGET="_top" TITLE="Roscommon Township">home</A>     <A HREF="id28.htm" TARGET="_top" TITLE="Ambulance">Ambulance</A>     <A HREF="houghton_lake_employee_handb.htm" TARGET="_top" TITLE="Employee Handbook">Employee Handbook</A></div> <bR> <bR> <bR> <bR> <div> </div> </td> </tr><tr> <td valign="top" height=398 style=" border-top: 5px solid #66FFFF;" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Interfacility Transfers</I></div> <DIV ALIGN="LEFT"></DIV> <div> <B>Houghton Lake Ambulance Authority</B></div> <div> <B>Local and interfacility transfer guideline</B></div> <bR> <div> Purpose: To define and describe the procedures for local and interfacility patient transfer services.  </div> <div> Definition: A transfer is a call which involves transporting a patient from one hospital  to another, from a residence or facility to a hospital for prearranged testing or from a hospital back to a residence.</div> <div> Procedure for Hospital to Hospital transfer:</div> <div> When contacted by the hospital for the transfer assess the following:</div> <div> We have at least one ambulance available for coverage for 911 calls.</div> <div> If transfer will continue beyond end of shift both personnel must agree to stay.</div> <div> Less than 120 mile transfer (generally Traverse City, Midland, Saginaw and Bay city).</div> <div> Is patient unable to be transported safely by any means other than ambulance including:</div> <div> Unable to get up from bed without assistance </div> <div> Unable to ambulate</div> <div> Unable to sit in a chair or wheelchair </div> <div> If “no” to above does pt require</div> <div> Restraints to prevent harm and/or injury to self or others</div> <div> Isolation precautions</div> <div> Cardiac monitoring</div> <div> Decubitus ulcers and requires wound precaution</div> <div> Oxygen monitoring by trained staff</div> <div> Must remain immobile because of a fracture that has not been set or the possibility of a fracture</div> <div> Contractures</div> <div> Ventilator dependent</div> <div> Exhibits signs of decreased level of consciousness</div> <div> IV therapy </div> <div> Other situations that require continuous medical care and assessment</div> <div> If patient meets above requirements obtain the following transfer information:</div> <div> Patient full name, Gender and Date of birth</div> <div> Pick up location including Hospital, Department and room #</div> <div> Drop off location including Hospital, Department and room #</div> <div> Primary insurance, Medical record #, Equipment needed & Communicable diseases</div> <div> Reason for transfer/Patient condition</div> <div> Transferring physician/Receiving physician</div> <div> Caller who arranged transfer</div> <div> On arrival at transferring facility you must:</div> <div> Obtain full report from nursing staff</div> <div> Have a face sheet and a Medical necessity form signed by the transferring physician</div> <div> If the transfer does not meet the above requirements for medical necessity, you must inform the patient/family that their insurance may not cover the cost of the transfer. If the patient still wishes to be transported, have them sign the <U>Notification of possible non-coverage of services</U> form.</div> <div> Procedure for Hospital to Residence/Assisted living or Nursing home, or Residence/Assisted living or Nursing home to Hospital for prearranged testing transfer</div> <div> When contacted by the hospital, patient or Assisted living/Nursing home facility assess the following:</div> <div> We have at least one ambulance available for 911 calls.</div> <div> If the transfer will continue beyond the end of shift both personnel must agree to stay</div> <div> Does the transfer begin or end in Roscommon or placeLake township?</div> <div> Is patient unable to be transported safely by any means other than ambulance including:</div> <div> Unable to get up from bed without assistance</div> <div> Unable to ambulate</div> <div> Unable to sit in a chair or wheelchair</div> <div> If the patient meets the above requirements obtain the following transfer information:</div> <div> Patient full name, gender and date of birth</div> <div> Pick up location (including facility, department & room # if applicable)</div> <div> Drop off location (including facility, department & room # if applicable)</div> <div> Primary insurance, medical record #(if applicable), equipment needed, communicable diseases</div> <div> Reason for transfer/patient condition</div> <div> Transferring physician (if applicable)</div> <div> On arrival at residence or transferring facility you must:</div> <div> Obtain a full report from nursing staff (if applicable)</div> <div> Obtain a face sheet and a signed Medical necessity form (if applicable) and a <U>Notification of possible non-coverage of services form</U>.</div> <div> Advise the patient/family that their insurance may not cover the cost of the transfer if the transfer requirements are not met.</div> <div> Special considerations:</div> <div> Responsibility for the patient during transport lies with the transferring facility until the patient arrives at the receiving facility.</div> <div> Any transfer referred to as “Stat” or “Emergency” should be transported as priority one</div> <div> Care initiated by the transferring facility may need to be continued during transport.  The transferring physician will determine the treatment to be provided during the period of the patient transport, and what, if any, staff will be necessary to accompany the patient enroute.</div> <div> The transferring physician may provide orders to the paramedic prior to transfer.  The orders must be consistent with the paramedics training and abilities. The paramedic has the right to decline transport if he/she is uncomfortable with the orders, or, alternatively, to insist a hospital staff member or another paramedic accompanies them on the transfer.</div> <div> Infusions may be continued during transport and must be maintained by an IV pump.  Should complications arise, infusions must be discontinued and Medical control contacted.</div> <div>   Patients who are hemodynamically unstable will not be transported by ALS units without accompanying hospital staff or a second Paramedic as deemed necessary by the on-duty Paramedic.  If the paramedic considers a patient unstable he/she may request hospital staff to accompany the patient. Alternate transport may be considered, i.e. MICU or air medical.</div> <div> Patients beyond the scope of practice of the transfer capability of Paramedics as defined by protocol must be transported with additional hospital staff or by alternate transportation, i.e. MICU or air medical.</div> <div> Should questions arise during transfer the crew may contact the sending physicians.  If this is not possible or in event of an emergency the appropriate protocol should be followed and Medical Control contacted for direction.</div> <div> The following information should accompany the patient (but not delay the transfer in acute situations):</div> <div> Copies of pertinent hospital record</div> <div> X-rays</div> <div> Copies of all test results and lab reports</div> <div> Written orders during transport</div> <div> Any other pertinent information</div> <div> Face sheet and Medical Necessity form signed by transferring physician</div> <div> If the patient becomes critically unstable or goes into cardiac arrest, divert to the nearest Emergency Room. If additional resources are necessary for transport call 911 for intercept as needed for assistance.</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> ###</div> <bR> <bR> <div> Approved December 2007</div> </td> </tr></table></body>