STEMI transfers

[DieselBolus]

AFAIK, medics are not regulated by EMTALA. If a medic were to be conscientious enough to transport a patient with an HMO to an in-network facility, thus foregoing an unnecessary IFT transfer down the road, and such decision didn't adversely affect the patient, I can't see why there would be any ramifications.

 

[jrm818]

It's more of a regulatory thing than the classic dumping situation. Things get tricky when you're not transferring appropriately and needfully. Don't know how this sort of thing would apply, but it's quite possible bypassing a legitimate destination would be considered a violation. [not a lawyer]

I've always wondered about this, especially now that I'm in a state where this sort of "keep them in the system" bypassing actually occurs. I was suprised the first time I saw it. It seems scuzzy to me.

I have done this once, sort-of. We bypassed several hospitals with a transfer form rural ED to urban VA hospital, lights and sirens (I know, I know) with a patient with deteriorating respiratory function....just to remain in the VA system. I wasn't comfortable with that either.

For what it's worth, CMS says this: "Hospitals that request transfers must recognize that the appropriate transfer of individuals with unstabilized emergency medical conditions that require specialized services should not routinely be made over great distances, bypassing closer hospitals with the needed capability and capacity." https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R46SOMA.pdf

 

[Brandon O]

AFAIK, medics are not regulated by EMTALA. If a medic were to be conscientious enough to transport a patient with an HMO to an in-network facility, thus foregoing an unnecessary IFT transfer down the road, and such decision didn't adversely affect the patient, I can't see why there would be any ramifications.

Certainly not, but that would be quite different. Anyway, transfers are the sending physician's responsibility, they'd be the one on the hook here.

For what it's worth, CMS says this: "Hospitals that request transfers must recognize that the appropriate transfer of individuals with unstabilized emergency medical conditions that require specialized services should not routinely be made over great distances, bypassing closer hospitals with the needed capability and capacity." https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R46SOMA.pdf

Yeah. Like many things, for me this'll fall into the "don't know if it's okay, hope I don't have to find out" category. For others, well... just remember that you can always file a complaint if necessary for your patients. Probably anonymously.

 

[DieselBolus]

I've always wondered about this, especially now that I'm in a state where this sort of "keep them in the system" bypassing actually occurs. I was suprised the first time I saw it. It seems scuzzy to me.

I have done this once, sort-of. We bypassed several hospitals with a transfer form rural ED to urban VA hospital, lights and sirens (I know, I know) with a patient with deteriorating respiratory function....just to remain in the VA system. I wasn't comfortable with that either.

For what it's worth, CMS says this: "Hospitals that request transfers must recognize that the appropriate transfer of individuals with unstabilized emergency medical conditions that require specialized services should not routinely be made over great distances, bypassing closer hospitals with the needed capability and capacity." https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R46SOMA.pdf

Thanks for the link JRM.

And thanks for the input, Brandon.

For some reason, I love this kind of stuff.

 

[Brandon O]

Future lawyer! Unclean!

 

[Ewok Jerky]

I have done this once, sort-of. We bypassed several hospitals with a transfer form rural ED to urban VA hospital, lights and sirens (I know, I know) with a patient with deteriorating respiratory function....just to remain in the VA system. I wasn't comfortable with that either.

For what it's worth, CMS says this: "Hospitals that request transfers must recognize that the appropriate transfer of individuals with unstabilized emergency medical conditions that require specialized services should not routinely be made over great distances, bypassing closer hospitals with the needed capability and capacity." https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R46SOMA.pdf

It comes down to your comfort level continuing transport with the sending orders you've received and what you can do with online med control. If your patient is dump and OMC isn't helping, diverting to closest facility might be in the patients best interest and any repurcussions on you should be limited if there are "issues" with the transfer. Likely the patient would end up getting 're-stabalized and transferred a few hours later.