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Transfer

Introduction

Date of Last Review 8/13/09
SME: Director of Financial Operations


The following provides guidelines for staff to ensure that a patient requesting or requiring a transfer for further medical care and follow-up is transferred appropriately.
Reference: EMTALA Flowchart

Policies

UTHCPC and UT-Behavioral Health Outpatient Services have written guidelines outlining the requirements for an appropriate transfer to another facility in accordance with federal and state laws which state:

Any transfer of an individual with an emergency medical condition must be initiated either by the written request from the patient or the legally responsible person acting on the patient's behalf for such transfer or by a physician order with the appropriate physician certification.

The transfer of a patient shall not be predicated upon arbitrary, capricious or unreasonable discrimination based upon race, religion, national origin, age, sex, physical condition or economic status.

Under no circumstances shall screening or transfer be delayed in order to inquire about the patient's method of payment or insurance status.

Patients may elect to transfer to an in-network facility. Some reasons for transfer may include:

Maximizing insurance benefits

Family concerns

Patient preference

The transfer is effected through qualified personnel and transportation and equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer.

Definitions

For an explanation of various terms regarding transfers see, EMTALA Definitions.

Transfer-in process

The following is the process for transferring a patient into UTHCPC:

Step

Responsible Department

Action

1

Transferring facility

Informs UTHCPC's Patient Registration of its intention to transfer a patient for emergency psychiatric care.

2

Patient Registration

Logs all transfer requests/inquiries on the Daily Central Log

Provides a bed based on current capacity

Determines whether a bed is immediately available

If no, informs transfer hospital of diversionary status.

If yes, requests and receives from transferring facility:

All pertinent medical information, including an EMTALA risk-benefit statement

A summary of the patient's condition

Completes Administrative/Medical Clearance form and attaches to information received from transferring facility.

Delivers information to on-call resident, or resident/house officer, or appropriate attending physician as scheduled by the Medical Director, for evaluation and consultation with referring physician

On all emergency requests, within 30 minutes of the initial contact from a hospital seeking to transfer a patient into UTHCPC, telephones or faxes the requesting hospital the transfer status determination

3

Physician

On all requests to transfer a patient into UTHCPC, the response time will occur within 30 minutes of the initial contact from the transferring facility.

Reviews patient information

Receives call from the treating MD or her/his resident (not a consultant)

Assesses UTHCPC capabilities

As appropriate, notifies Patient Registration of medical clearance

Writes admit order

4

Patient

Presents at UTHCPC with transfer documentation and proceeds with admission process.

5

Patient Registration and MD

Completes appropriate sections of Memorandum of Transfer (MOT)

Transfer-out process

The following is the process for transferring a patient out of UTHCPC:

Step

Responsible Department

Action

1

Physician

Determines medical necessity following a medical screening examination or based on patient's progression in ongoing treatment

Calls receiving facility's transfer department personnel and MD to notify of transfer and provide current medical status

Writes MD order specifying transfer facility and mode of transportation

Completes the risk-benefit statement following consultation and patient

Signs/completes the MOT in appropriate space

If patient is admitted to the other facility, the UTHCPC physician must complete the following:

Discharge order

Discharge summary and note as required.

2

RN/Nursing staff

Notifies Nurse Manager or Nursing Supervisor of impending transfer and possible need of staff escort

Calls the family or next of kin to notify them of the transfer

Arranges transportation based on MD order

Ensures completion of MOT including risk-benefit and patient's consent to transfer

Photocopies the following information (if available) to be sent with the patient:

History and physical

Physician orders

Pertinent progress notes

Laboratory results

Consultations

Vital sign record

Medication administration record

Any other pertinent information

Calls Security to inform them about transportation, and the need to escort to the appropriate unit, if applicable

Escorts (preferably the same gender as patient) the patient

Escorting staff maintains contact with the Charge Nurse/Nursing Supervisor at a minimum of every 2-3 hours regarding the patient's status

3

Social service clinician

Notifies court of involuntary patients (OPC, etc.) transferring out and arranges transportation with the Constables.

Related standards

Medicare Conditions of Participation Interpretive Guidelines (EMTALA) Reg 489.20, TAG A407

The Joint Commission:  Provision of Care , Treatment and Services
                                        Ethics, Rights, and Responsibilities

 

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Harris County Psychiatric Center University of Texas Health Science Center