Transfer of Patients to the National Military Hospital

1. Transfer of Patients to the National Military Hospital

2. Goals of Patient Transfers • Simple Process • Patient Focused Process – “what is best for patient is guiding tenet of plan” • Physician to Physician referral • Enhanced Relationships between facilities and moves towards improving physician acceptance of transfers

3. Current State: Defined • Needs to be ‘One Call’ to trained personnel to initiate the transfer • Bed Availability issues – Referring physician must make sure the NMH has resources to care for patient • The referral system needs to be monitored and continually improved

4. Benefits: • Improved Patient Transfer Process • Improved Continuity of Care across the system for the patient and their families • Keep ANA patients in one system in order to optimize sharing of information and patient records between the health care professionals who are caring for the patient.

5. Receiving Hospital’s Obligations – Appropriate Transfers • Professionals at the National Military Hospital will agree to accept the patient if the patient requires the specialized capabilities of the NMH . • If the regional hospital wants to transfer a patient because it has no beds or is overcrowded, but the patient does not require any "specialized" capabilities, the NMH may not feel obligated to accept the patient.

6. Referring Hospital Obligations • Stabilize the patient as much as possible • Determine the treatment to be provided during transport • Assure that all medicines and equipment needed for the transfer are included with the patient • Assure that proper personnel to continue treatment are included with the transfer

7. Transfer Continued • Provide written orders to accompany the patient • Maintain appropriate medications during the transfer • Assure that any medical regulatory devices needed accompany the patient (ventilators, IV pumps etc) • Assure that personnel accompanying the patient are capable of operating necessary medical devices

8. Patients with chest tubes maintained adequately with Heimlich valves may be transferred if cleared with the NMH receiving physicians. • Any medications or procedures given during the transfer will be recorded and briefed to the receiving physician on arrival at the NMH.

9. Arrival at the NMH • Accompanying personnel will brief the receiving physician on arrival • Copies of records will be transferred • Xrays and results of laboratory reports will be transferred • All procedures , medications or changes in the condition of the patient during transport will be discussed with the receiving physician

10. Professionals at the NMH will: • Examine the patient and review the records with the accompanying professional • Contact the referring physician with follow up reports on the patients condition • Notify the referring facility when transfer back to the referring facility is planned. • Provide a written follow up plan for the patient as required

11. Patient Transfers • Medical Emergency Screening • On-Call Physicians • Obligation to Accept Transfers

12. First Principle of Patient Transfer • Medical Screening Exam • Stable - Stable for Transfer when you can state about the patient, within reasonable clinical confidence, that there will be no material deterioration in his/her medical condition during transport • Unstable - You shouldn’t transfer unstable patients, unless the benefits of transfer outweigh risks

13. 1) Notify the on-call physician or chief of staff when you feel transfer may be needed2) Maintain stabilizing efforts3) Transfer if necessary and document the name and phone number of the on-call physician in the transfer documentation

14. Assume the patient may have a more imminently serious problem and further delay in obtaining appropriate consultation might place the patient’s health in jeopardy.

15. If the patient needs immediate attention, first the hospital must do everything it can within its capabilities and capacity (resources) to stabilize the patient. Communication between the referring physician and an on-call physician at the NMH may be necessary regarding whether the patient is stable enough for transfer.