INTRA and INTERhospital Transfers

Admitting a Patient from Clinic to Inpatient

The inpatient unit at YKHC in Bethel is referred to as “North Wing.” 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 clerk or inpatient clerk at x6330 can help you determine which provider you should page. Chronic Pediatric Patients (designated with CPP in the alert section) 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 and follow the same flow as below. You can call the Pediatric Hospitalist if you have a question about whether you should admit the patient or not or if the patient is appropriate for the family medicine or pediatric inpatient service. The ward doctor will need to write the admitting orders once your Clinic Clerk has called registration and gotten an admission FIN (account number). There are different FINs for each encounter, so the Admission encounter FIN will be different from the ED or Ambulatory encounter FIN. The admitting provider may come to clinic or ED immediately to see the patient, but more likely they will ask you about the patient and then the doctor will see the patient on the floor. Consult with the ward doctor about which antibiotics to start, fluids etc., so those can be started in the outpatient side and get the admission process initiated more quickly. Our hospital admissions are mainly large abscesses and/or cellulitises that have failed outpatient treatment, large lower extremity cellulitis/abscesses that have not yet had outpatient treatment, pneumonia, bronchiolitis, suicidal ideation, COPD exacerbation, fever in a neonate, and labor.

Patient Admission Flow from Clinic:

• Outpatient Provider to contact Northwing provider for 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.
• Determine if admitting provider will be seeing the patient in clinic or if patient may be transferred to inpatient unit.
• Alert the office assistant and Charge nurse of your plan for admission so they can obtain a preadmission FIN # (outpatient nurse to call ER registration x6905, usually 3-5 minutes for them to call back)
• Outpatient nurse or office assistant to Tiger text the admitting provider with FIN # so orders can be written.
• Clinic charge nurse will contact charge nurse on NW for a “heads up”
• Complete your clinic documentation and interventions as needed. Please keep patient and family updates on status of transfer.
• Once bed has been assigned, provider on NW completes admission orders; clinic nurse will provide sign out to admitting nurse on Northwing (include recent vitals, Hx, diagnosis, etc).
• Patient transferred to assigned room on inpatient unit after report given.

Transferring a patient from Clinic to Emergency Dept

Outpatient Provider

1. Call ED physician to obtain an accepting physician. Inform clinic charge nurse and ED charge nurse of transfer to ER.
2. Complete clinic documentation with important transfer information.
3. Nurse will give report to ER and transfer patient to ER when room available.
4. Always keep parent/patient informed of status of situation
5. IF you have an emergent patient, call a Rapid Response
6. IF you have an unstable, unresponsive patient in clinic have the clerk call a code blue.

Transferring a Patient from clinic to Anchorage via Commercial Flight or Medevac

1. Contact accepting facility. ANMC/Providence contact appropriate on call service. 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. 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.
3. If patient is unstable, activate Rapid Response or Code Blue as appropriate and [[:Category:Medevacs and Transport#Medevac Activation Process|initiate transfer via Medevac]. Patient will need to be transferred to ER until transport arrives. See transfer to ER section.
4. Complete Raven note / transfer summary with pertinent details.
5. Obtain all radiological images on disk from radiology department.
6. Complete Transfer form (PTOS) with all appropriate signatures.
7. Remind clerk to print out all Raven documents and labs and place in transfer packet.
8. Always keep patient/caregiver informed of status of situation.