Psych Transfer: Questions

[BaLisTeK]

Hello everyone, my name is Ron. I am hoping some of you will help me gather some information or point me the right direction.

First off, I am about to be a new grad RN. A buddy (new grad RN) and I are looking into starting a private transportation service (mostly inter-hospital) for PEC/CEC patients. Currently, hospitals are using the local EMS as their personal transport service. From a fiscal standpoint, it is costing transferring hospitals and the state a good bit of money. I am debating whether or not to contact my local EMS service get their viewpoint of a private psych transfer service.

My questions are:
1. Do you think this is a good idea?
2. As EMT's, would you prefer to have a such service?
3. Can anyone point me in a good direction towards regulations or insurance reimbursement policies?

Any other wisdom in this area would be greatly appreciated. It just seems that the use of EMS in areas with limited vehicles is not appropriate. I know I am probably forgetting somethings in my description, but I look forward to your thoughts and ideas.

Thanks,
Ron

 

[JPINFV]

1. Personally, if done right, yes, I think it's a good idea for a handful of reasons. First off, you can use specially trained providers. The psychiatric component of most EMT-B education is extremely weak and most of the diseases aren't covered. I'm fairly certain (I honestly don't feel like looking), for example, that schizo-affective disorder is even mentioned. With a private transport service, you have the advantage of being able to separate the patient from transport crew if need be (for example, use a sedan) without the stigma of being transported by the police (albeit police is normally scene->hospital if anything). Additionally, when you do need to use restraints, you know that the people using them has more than a cursory knowledge of restraint and take down practices as well as regular experience (well... regular compared to your average EMT).

2. Me, personally, I wouldn't care. I never begrudged psychiatric transports. Albeit I would cheer at the fact that a lot of EMS providers would never get to do another transport. However, ambulance companies themselves aren't going to like to see this money fountain go dry. I think your big problem, however, is going to be state law regulating the transport of patients, especially patients who are detained under temporary (including temporary conservatorships) holds or conservatorships.

 

[junno328]

Psyche transfers can be catchy. I am not an EMT, but I am a dispatcher. We have protocols that we follow and ask questions of PT's history, if the PT is combative or sedated, if PT is on a hold or is voulntary. As far as insurance goes, id say 90% of insurance should cover the transport. Psych Pt's are out "unique" transports and do need supervision. ****never send a psych on a wheelchair transport*** this is ugly, trust me, it wasnt pretty

 

[Veneficus]

I think you should look up the payment for specialty transport from medicare/medicade. If the service costs more than standard IFT, why would anyone pay it?

Most psych is grossly underfunded as is, an EMT is much cheaper than an RN.

As for advanced care, what exactly could be provided? Usually a psych patient is coming from a facility medically clear, going to a facility that does not accept patients who are not. I have been to many facilities as a paramedic who would not accept deeply sedated patients.

I agree that a specialty RN can provide much better care than an EMT or even a paramedic to a psych patient, I am not sure where the value comes in.

 

[JPINFV]

What I'm talking about doesn't even have to be a specialty RN. How about someone who has even a basic understanding of the various syndromes and disorders? Formal training in verbal deescalation? Take downs and restraint practices (past the basic overview done in EMT-B class)? These aren't complicated topics in and of themselves, but they just aren't covered in depth that they need to be fully useful for these transports.