INTRA and INTERhospital Transfers

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The inpatient unit at YKHC is on the third floor of the hospital and is referred to as North Wing (NW). From 0800 – 1800 there are two family medicine physicians staffing NW, one for Yukon villages and one for Kusko villages. There is inpatient pediatric coverage 24 hours a day.

If you are seeing an adult or uncomplicated non-CPP patient you feel needs to be admitted, Tiger Connect the North Wing ward doctor for that village. The clinic, ER, or inpatient (x6330) clerk can help you determine which provider you should page.

Chronic Pediatric Patients (designated with CPP in the Alerts on the banner bar in PowerChart/FirstNet) and complicated non-chronic pediatric patients are admitted to the pediatric service. If you are admitting to Pediatric Service contact the pediatric provider on call via Tiger Connect role 'Peds Wards on Duty.' Once the decision has been made for admission, the inpatient pediatric provider assumes the responsibility of disposition; if they feel on reviewing the case that the patient is not ill enough to warrant admission they are responsible for discharging the patient from the emergency room.

Your clerk will help with the admitting process. An inpatient Financial Identification Number (FIN) is needed before the NW physician can write orders. There are different FINs for each encounter, so the Admission encounter FIN will be different from the ED or Ambulatory encounter FIN.

Consult with the ward doctor about a treatment plan. If antibiotics or fluids are needed, they can be started in the outpatient clinic or ED. Typical hospital admissions include large abscesses and/or cellulitis, pneumonia, bronchiolitis, suicidal ideation, COPD exacerbation, fever in a neonate, and labor.

You can always call Pediatrics or the Family Medicine ward docs if you have a question about whether you should admit the patient.

Admit from ED to NW (Inpatient)

ED Provider

  • After assessment and work-up, deems admission is warranted
  • Contacts the NW provider to discuss admission (Providers are divided into 2 sections: Yukon and Kusko depending on which village the patient is from will determine which provider you page or Chronic Peds. The clinic clerk can help assist you. Bethel admissions will go to the least busy family physician, so you can contact either one and might be bounced to the other physician.)
  • Communicates with ED nursing staff that patient will be admitted
  • Places the order Decision to Admit

Decision to Admit.png

  • Completes the Admission Medication Reconciliation
  • Complete documentation and interventions as needed. Please keep patient and family update on status of transfer.

ED Nursing Staff

  • Communicates with NW Charge nurse that the patient will be admitted
  • Verifies bed status with NW Charge nurse
  • Requests Pre-Admit FIN to be entered by ED clerk
    • NOTE: the Pre-Admit FIN can be accessed in First Net and Power Chart by changing the location in the blue banner bar

Banner bar location.png

  • Tiger text the admitting provider with FIN # so orders can be written.
  • Calls report to NW RN

NW Provider

  • Determine if you will be seeing the patient in clinic or once transferred to inpatient unit.
  • Accesses the patient’s chart, finding the newly created Pre-Admit FIN (NOTE: orders must be entered from the correct FIN)
  • Places admitting diagnosis on the encounter
  • Order "Admit to Inpatient or Observation"

Admit to order.png

  • Enter the admission Power Plan: MED Adult Admission, PED Pediatric Admission, or MED Adult Admission Holding Orders
    • NOTE: the ED Provider may, at times, enter the MED Adult Admission Holding Orders

Admission Orders.png

  • Selects “Plan for Later” when signing the Power Plan
  • Completes the Admission Medication Reconciliation AFTER the transfer is complete
  • Informs NW RN the orders are entered

NW RN

  • Receives report from ED RN
  • Requests NW clerk contact Registration to change the Pre-Admit FIN to Inpatient FIN (communicating the patient’s room number)
  • Initiates Admission orders
  • Notifies NW Provider when patient arrives

Admit from Outpatient (Ambulatory) to NW

Outpatient Provider

  • Assesses/evaluates the patient and deems admission is warranted
  • Contacts NW Provider to discuss admission (Providers are divided into 2 sections: Yukon and Kusko depending on which village the patient is from will determine which provider you page or Chronic Peds. The clinic clerk can help assist you. Bethel admissions will go to the least busy family physician, so you can contact either one and might be bounced to the other physician.)
  • Communicates with OP Clinic/Charge RN
  • Completes the Outpatient Medication Reconciliation
  • Complete clinic documentation and interventions as needed. Please keep patient and family updated on status of transfer.

OP Clinic/Charge RN

  • Communicates with NW Charge nurse that the patient will be admitted
  • Verifies bed status with NW Charge nurse
  • Requests Pre-Admit FIN to be entered by Outpatient clerk (call ER registration x6905, usually 3-5 minutes for them to call back)
  • Tiger text the admitting provider with FIN # so orders can be written.
  • Calls report to NW RN

NW Provider

  • Determine if you will be seeing the patient in clinic or once transferred to inpatient unit.
  • Accesses the patient’s chart, finding the newly created Pre-Admit FIN (NOTE: orders must be entered from the correct FIN)
  • Places admitting diagnosis on the encounter
  • Order "Admit to Inpatient or Observation"

Admit to order.png

  • Enter the admission Power Plan: MED Adult Admission, PED Pediatric Admission, or MED Adult Admission Holding Orders

Admission Orders.png

  • Selects “Plan for Later” when signing the Power Plan
  • Informs NW RN the orders are entered
  • Completes the Admission Medication Reconciliation AFTER the transfer is complete

NW RN

  • Receives report from Outpatient RN
  • Requests NW clerk contact Registration to change the Pre-Admit FIN to Inpatient FIN (communicating the patient’s room number)
  • Initiates Admission orders
  • Notifies NW Provider when patient arrives

Admit from OB Triage to OB Inpatient

OB Provider

  • Places admitting diagnosis on encounter (NOTE: uses the same FIN as in OB Triage)
  • Enters Admission Power Plan: OB Labor and Delivery Admit and OB Postpartum

OB Admission Orders.png

  • Selects “Plan for Later” when signing the Power Plan
  • Informs OB RN the orders are entered
  • Completes the Admission Medication Reconciliation AFTER the transfer is complete

OB RN

  • Requests NW clerk contact Registration to communicate the admission and the patient’s room number
  • Initiates Admission orders

Direct Admit to NW

NOTE: Patients may be directly admitted from ANMC, the village, or another health care facility

NW Provider

  • Has been in contact with a provider regarding the admission
  • Accepts the admission directly
  • Accesses the patient’s chart, finding the newly created Pre-Admit FIN (NOTE: orders must be entered from the correct FIN)
  • Places admitting diagnosis on the encounter
  • Order "Admit to Inpatient or Observation"

Admit to order.png

  • Enters the admission Power Plan: MED Adult Admission, PED Pediatric Admission, or MED Adult Admission Holding Orders

Admission Orders.png

  • Selects “Plan for Later” when signing the Power Plan
  • Informs NW RN the orders are entered
  • Completes the Admission Medication Reconciliation AFTER the transfer is complete

NW RN

  • Receives report from RN at transferring facility
  • Requests NW clerk contact Registration to create a Pre-Admit FIN
  • After the patient arrives, requests NW clerk contact Registration to change the Pre-Admit FIN to Inpatient FIN (communicating the patient’s room number)
  • Initiates Admission orders
  • Notifies NW Provider when patient arrives

Transfer from LTC to ED

LTC Provider

  • Assesses/evaluates the patient and deems emergent evaluation is warranted
  • Or, receives report from LTC RN that the patient needs emergent evaluation
  • Contacts ED Provider to discuss transfer
  • Communicates with LTC Charge RN
  • Documents the rationale for transfer
  • Completes the (INSERT WHICH ONE) Medication Reconciliation

LTC RN

  • Communicates with ED RN that the patient will be transferred
  • Calls EMS for transport
  • Calls report to ED RN

ED Provider

ED RN

  • Receives report from LTC RN
  • Cares for patient as any other ED patient

Transfer from Ambulatory to ED

Outpatient Provider

  • Assesses/evaluates the patient and deems emergent evaluation is warranted
  • Contacts ED Provider to discuss transfer (Activate Rapid Response or Code Blue if necessary)
  • Communicates with OP Clinic/Charge RN
  • Documents the rationale for transfer
  • Completes the Outpatient Medication Reconciliation

OP Clinic RN

  • Communicates with ED RN that the patient will be transferred
  • Calls report to ED RN
  • Transports patient to the ED, providing a warm hand-off

ED Provider

ED RN

  • Receives report from OP Clinic RN
  • Cares for patient as any other ED patient

Transfer from ED to LTC

ED Provider

  • Assesses/evaluates the patient and transfer back to LTC is appropriate 
  • Contacts LTC Provider (or LTC RN after hours) to discuss transfer
  • Communicates with ED RN
  • Documents the rationale for transfer
  • Completes the Discharge Medication Reconciliation

ED RN

  • Communicates with LTC RN that the patient will be transferred
  • Calls report to LTC RN
  • In conjunction with ED clerk, arranges transport of the patient to the LTC

LTC Provider

  • Evaluates patient upon return to LTC
  • Updates orders as needed

LTC RN

  • Receives report from ED RN
  • Reviews new orders if indicated
  • Cares for patient as any other LTC patient

Transfer from NW to LTC

NW Provider

  • Assesses/evaluates the patient and discharge back to LTC is appropriate
  • Contacts LTC Provider to discuss transfer
  • Communicates with NW RN
  • Completes the Discharge Medication Reconciliation
  • Completes Discharge Summary

NW RN

  • Communicates with LTC RN that the patient will be transferred
  • Calls report to LTC RN
  • In conjunction with NW clerk, arranges transport of the patient to the LTC

LTC Provider

  • Evaluates patient upon return to LTC
  • Enters new admission orders

LTC RN

  • Receives report from NW RN
  • Enters a Pre-Admit FIN for the patient upon notification the patient will be transferred back to LTC
  • Switches the Pre-Admit FIN to an Admit FIN once the patient arrives
  • Reviews admission orders
  • Cares for patient as any other LTC patient

Please Note: Timing of transfer from NW to LTC is dependent on nursing staff.

Admission Reminders

  • The correct FIN is key!
    • If the correct FIN/encounter is not in the chart, contact registration to have it entered
  • Always use the Admission Power Plans to enter orders; if an order is not on the Power Plan, select “Add to Phase” to enter it.

Add to Phase.png

  • Document using the proper Note Type:
    • NW Admission History & Physical
    • NW Pediatric Admission H&P
    • OB Maternal Admission H&P
  • Add an admission diagnosis
  • Remember to place your E&M charges
  • Admission Medication Reconcillation must be completed AFTER the patient has been admitted and arrived on the floor
  • Reconcile the patient’s Problems and Allergies on admission
  • Communicate with the ED if a patient from NW, OB, or a village will require Life Med transport to Anchorage

Critical Care Transfers between Inpatient Ward and ED

  • This occurs on a case-by-case basis and must be discussed with the ward provider, ED provider, ward charge nurse, and ED charge nurse.
  1. Anticipate 5-6 minute transport time IF everything goes smoothly. Appreciate risk of unanticipated obstacles/obstructions (such as long elevator wait, maintenance working in the hall, etc).
  2. Secure ET tube with a tube holder. If reasonable, place OG tube prior to the tube holder.
  3. Establish two working IV's.
  4. Either sedate with long acting meds (versed, fentanyl, etc) or use an infusion pump for propofol. Bolusing propofol in route is discouraged.
  5. Transfer on a gurney rather than a hospital bed (the large size of a hospital bed is problematic in the elevator and more difficult to navigate past equipment in the hallway).
  6. Place ventilator, O2 tank, monitor, etc. ON THE GURNEY (at the foot). Minimize the amount of equipment pushed alongside the gurney.
  7. Secure the patients' wrists (to prevent them pulling out the ET tube in route).
  8. Transport with an AMBU bag, mask, and oral airway even if the patient is inbutated and on a ventilator. Be prepared to ventilate the patient in the case of ventilator failure and/or unintended extubation in route.

Transferring a Patient from clinic/inpatient/Emergency Department to Anchorage via Commercial Flight or Medevac

see Medevacs and Transport for full details.

  1. Contact accepting facility. ANMC/Providence contact appropriate on call service. (e.g.: the surgeons take all trauma patients, the intensivists take all intubated patients, etc.) Once you have obtained an accepting physician initiate transport. Remember if you are transferring a native patient to a non-native facility you will need to obtain approval from contract health at ANMC.
  2. All patients who require medevac to ANMC go by LifeMed, the air ambulance service that is 50% owned by YKHC and 50% by Providence Hospital in Anchorage. You have to activate this service as soon as you have an accepting doc at ANMC. ANMC uses Guardian for their air ambulance service, but you must use LifeMed, unless the LifeMed service is busy and you believe that delaying the transport until a LifeMed flight is available would be unsafe for the patient.
  3. If patient is stable, contact our travel office and complete a patient transport order form. Have parent sign a consent to transfer patient and discuss risk/benefit. If commercial flights are full and no charter available for a few days, the decision might be made to transfer by Medevac.
  4. If patient is unstable, activate Rapid Response or Code Blue as appropriate and initiate transfer via Medevac. Patient will need to be transferred to ER until transport arrives. See Transfer from Ambulatory to ED and Critical Care Transfers between Inpatient Ward and ED.
  5. Complete Raven note / transfer summary with pertinent details.
  6. Obtain all radiological images on disk from radiology department.
  7. Complete a Patient Transport Form (PTO) with all appropriate signatures.
  8. Complete a paper consent for transfer if sending by medevac, signed by you and the patient.
  9. Remind clerk to print out all Raven documents and labs and place in transfer packet.
  10. If the patient’s condition changes, call and update the accepting doc (for example if you have to intubate the patient, let them know because this affects where the patient can go.)
  11. For patients who are traveling via commercial flight to Anchorage, the provider can authorize this travel if the patient does not have Medicaid or a means to pay for travel. See Preauthorized Travel
  12. Always keep patient/caregiver informed of status of situation.


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