Transfer Algorithm and Transfer Call Guidance
Transfer Calls Process
It all starts with a call from the Transfer Center that rings on your desktop phone at the attending chair. The transfer center extension is 43915 if you need to reach them.
There is an EPIC tab called ED TRANSFERS IN
Open that up and most times you will see the patient’s name and you can click on it to open up the chart. (If you don’t see the patient’s name, ask transfer center to start a chart.)
Once you click on the name and open the chart, please ALWAYS write a note in in that window, do not exit and write a note in another part of the patient’s chart. Use “ED Notes” in that window.
Talk to the sending provider about the patient.
Complete note and then fill out the “Accept/Not Accept” area.
Dr. Lynda Daniel has a dotphrase to use for charting if you want to steal it: .transfernote
Please continue to accept all “continuation of trauma” requests even if they seem inappropriate. This is the recommendation from the committee, trauma services and legal counsel. All “continuation of trauma” cases are reviewed and discussed with transferring hospital when required.
NO MATTER THE SURGE LEVEL (1, 2, 3, 4 OR 5): We take ischemic strokes (<24 hours since onset), non-traumatic SAH-ICHs, aortic dissections (type A and B WITH approval from surgeons), traumas and STEMIs (During daytime hours we can take 2 STEMIs at a time; at night and on the weekends, we can only take one at a time—rarely capacity issues arise).
We always take transfers from our OB ED in the CH.
We take all transfers from clinics or urgent cares without regard to capacity. These are just heads up or courtesy type calls. Please still document on them.
The rest of what I say will not refer to those patients mentioned above:
IF WE ARE OFF SURGE 1: We can take any ED to ED transfer. You may also want to give the requested service a heads up.
We have occasional limitations for ophtho subspecialists, so call to make sure we have oculoplastics etc before accepting those patients.
If we get a call for an ED transfer that is ICU level of care; do not accept to the ED. Make the patient a direct admit or refuse the transfer (if Tx Center staff says we have no ICU beds). We do not want ICU patients boarding in our ED.
We DO NOT accept Kaiser lateral transfers. Just ask if the transfer is for higher level of care or because of insurance.
SNAKEBITES ARE NOT automatically accepted if we are on capacity.
Hand Transfers
1. If it's obviously meets icema or our LLU trauma criteria, please accept
2. If you get a transfer call about a hand where you aren't sure if it meets criteria for trauma or for reimplantation, we ask that you loop in the ACS/Trauma attending into the conversation to help in the decision making. Though you might think those questions should be directed to plastics/Ortho on call, we been having some issues with those services declining transfers when it has been later decided that in person assessment would have been better. We also take reimplantation cases if the surgeon has capacity. Discuss with hand on call FIRST before accepting.
3. If it's clearly not something that needs either hand or plastics, you can continue to decline without involving trauma or the hand service.