improving pt care on call

[spaslam]

I am wondering how your program handles call particularly non emergent after hour admissions.

we have had an increase in after hour non-emergent admissions and transfers from outside VA and other hospitals. how does your program handle that? do you have to take them at any time? or do you have a policy of waiting for the next day when the primary treatment team is in? we are trying to encourage admissions during the day for better pt care, but are getting resistance. the claims are that the VA is required to take the pt's ASAP. does anyone know if this is true policy?

also what about after hour admissions at non VA hospitals? do on call residents admit non emergent transfer patients, or do they have to wait until the next day.

we also cover a NY state hospital. sometimes we get multiple child/adolescent transfer admissions after hours. are you required to do these as well? curious as to what other programs go through. we feel we can sigificantly improve pt care by asking the administartors to limit the non emergent admits to day time hours. what do others think?

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[Doc Samson]

I am wondering how your program handles call particularly non emergent after hour admissions.

we have had an increase in after hour non-emergent admissions and transfers from outside VA and other hospitals. how does your program handle that? do you have to take them at any time? or do you have a policy of waiting for the next day when the primary treatment team is in? we are trying to encourage admissions during the day for better pt care, but are getting resistance. the claims are that the VA is required to take the pt's ASAP. does anyone know if this is true policy?

also what about after hour admissions at non VA hospitals? do on call residents admit non emergent transfer patients, or do they have to wait until the next day.

we also cover a NY state hospital. sometimes we get multiple child/adolescent transfer admissions after hours. are you required to do these as well? curious as to what other programs go through. we feel we can sigificantly improve pt care by asking the administartors to limit the non emergent admits to day time hours. what do others think?

Our nation's EDs are in crisis, stacked to the rafters with patients they can't shift. If you have a bed, it's the right thing to take the patient whatever time of day it is. Whatever your quality deficits are, it's still better than leaving the patient in an ED (for the patient, and for whoever's stuck in the ED waiting room because they're not moving). I don't know of any hospital (state, federal, or private) that doesn't take "after hours" admissions.

 

[kugel]

EMTALA regs state essentially:
If the emergency pt needs specialized care that is not available at the current facility (b/c of lack of capability or capacity), and the intended receiving facility HAS capability (the spec. services) and capacity (bed), then the receiving facility MUST accept the pt when the sending facility states that the pt is sufficiently stable for transfer.
Note: the keys are capability/capacity at both facilities
Note: pt's on an inpatient unit (med or psych) are NOT emergency pt's
Note: EMTALA applies to facilities accepting federal (Medicare) payments
Note: sender needs to show that the pt NEEDS the intended specialty services (locked inpt psych care) and that the pt is medically stable (though ultimate responsibility for whether the pt is stable for transfer is on the sending physician).

IF there is a complaint against your hospital for when you do/don't accept transfers, the investigators will judge
A) do your hospital's policies conform to EMTALA regs?
B) did YOU follow your hospital's policies?

When in doubt about laws/regs consult your hospital Risk Mgt attorney. Do NOT accept your attending's/chief's interpretation of the laws (they are reasonably often wrong) unless you are specifically directed to do so while you are under supervision (student/resident).

I've researched this fairly well and I've been through investigations of ETMALA complaints, and I've initiated some EMTALA complaints.

All of this has little to do with what's morally correct.

 

[whopper]

we have had an increase in after hour non-emergent admissions and transfers from outside VA and other hospitals. how does your program handle that?

I had things like that. Not exactly what you had. I think what's going on here is the higher ups in the department have to communicate with the administration & they have to contact the other hospitals on working together. I don't know if you're a resident, but if you are, you can only make suggestions to your attendings. You can't communicate to the other departments unless the department let's you do so, because if you do try to implement changes outside your department, you're going over their head--which is a possibly professionaly dangerous boo-boo.

If you notice particular repeating patterns that cause problems, hopefully your program can react to them.