Transfers

[truetiger]

This is more for the 911 services that also do transfers. Anyone have a hospital in your service area that spits out an unreasonable amount of transfers? For things like simple pneumonia, non-complicated dislocated shoulders, general admission, etc?

 

[JPINFV]

This is more for the 911 services that also do transfers. Anyone have a hospital in your service area that spits out an unreasonable amount of transfers? For things like simple pneumonia, non-complicated dislocated shoulders, general admission, etc?

Are these emergent transfers or non-emergent transfers? There are many reasons to transfer a patient, some medical, some fiscal (insurance), some competence (maybe the physician in the rural hospital doesn't feel comfortable doing a certain procedure with no backup).

 

[truetiger]

Both. It's also not an acute access facility. The facility actually has quite a few beds. We often find out these patients are discharged not long after arriving at the receiving facility.

 

[JPINFV]

Number of beds doesn't equate to what the treating physician is comfortable doing... and when the last time they did said procedure.

 

[truetiger]

I'm not specifically referencing critical patients in which a transfer is arranged for someone who may be septic and doc x isn't comfortable with a central line. By no means would I want doc x to attempt said central line if they're not comfortable with it. But what about patient's that have lets say uncomplicated hyponatremia? Simple pneumonia? UTI's? Transfers due to patient request? As the search for a solution to the ever rising healthcare costs continue should we maybe start to look at things like these?

 

[MMiz]

I'm not specifically referencing critical patients in which a transfer is arranged for someone who may be septic and doc x isn't comfortable with a central line. By no means would I want doc x to attempt said central line if they're not comfortable with it. But what about patient's that have lets say uncomplicated hyponatremia? Simple pneumonia? UTI's? Transfers due to patient request? As the search for a solution to the ever rising healthcare costs continue should we maybe start to look at things like these?

I've been out of the game for a while, but wouldn't the facility be penalized under the new system?

I thought excessive transfers and discharges without treatment led to audits and loss of funding?

 

[truetiger]

I would hope so. It's to the point to where they just write down diagnoses on the forms so that they can "justify" the transfer. I've taken 20 yr olds to the cardiac floor when their real problem was the low white count and pelvic fluid, just because they had a "syncopal episode." The syncopal episode was very questionable.

 

[JPINFV]

I would hope so. It's to the point to where they just write down diagnoses on the forms so that they can "justify" the transfer. I've taken 20 yr olds to the cardiac floor when their real problem was the low white count and pelvic fluid, just because they had a "syncopal episode." The syncopal episode was very questionable.

Without seeing the entire H&P, it's "questionable" until you're facing the liability for missing it.

 

[JPINFV]

But what about patient's that have lets say uncomplicated hyponatremia? Simple pneumonia? UTI's?

None of those should be admitted anyways, based specifically off of those diagnoses and without any further knowledge of the patient's presentation or history.

Transfers due to patient request?

What's wrong with being transferred due to a patient's request or for insurance reasons?

As the search for a solution to the ever rising healthcare costs continue should we maybe start to look at things like these?

What percentage of health care spending is taken up by transfers between acute care hospitals not including transfers for higher levels of care?

 

[Gymratt]

Most of the hospital transfers we encounter is due to specialty procedures not performed at sending facility or by patient request. Some of these requests are to be transferred to what would be considered a downgrade in care. They prefer their own doc oversee their care. We have around 12 hospitals of various levels and capabilities within about a 50 mile radius so people don't always live close to their provider but for emergencies will come to the closest hospital.

I have also heard of doctors transferring a patient to a facility where an original procedure was performed but who is not having complications with said procedure. Due to the on going issue they prefer to allow the original doc to continue treating the patient so will transfer them.

If we have a transfer that our billing department feels that insurance will not pay they often have patient sign saying they understand and take full responsibility for the cost of the transport.

Also you can usually set your clock by when the transfers will start rolling in as docs tend to do rounds in the evening and begin discharging patients after lunch or at least here they do. Mornings they are either in surgery or have office hours or both. Evenings they make rounds. So it seems the hospitals wait and dump patients all at once.

 

[Aprz]

You should be be asking why they are being transported to another facility and documenting that. Regardless of diagnosis, you will frequently transport patients due to insurance or patient's preference. They may be discharged quickly after evaluation at the receiving facility.

I actually dislike the syncope automatically must remain on an ECG and go to telemetry, but that's common too. Although they have found other causes for the syncope, I think they want the patient to remain on telemetry because they are unsure if an arrhythmia caused the initial syncope. Usually these transports to telemetry are because of insurance preference (ER at facility that isn't covered by insurance to ER or telemetry of covered facility) or no available bed at the sending facilities telemetry department.

If it's all covered by insurance, I don't really have a problem with it.

 

[TransportJockey]

This is more for the 911 services that also do transfers. Anyone have a hospital in your service area that spits out an unreasonable amount of transfers? For things like simple pneumonia, non-complicated dislocated shoulders, general admission, etc?

my little level 4 hospital in my county transfers out damn near everyone. most go by fixed wing, but when they're out one of our two ambulances does the transfer