INTRA and INTERhospital Transfers

Admit from ED to NW (Inpatient)

ED Provider

• After assessment and work-up, deems admission is warranted
• Contacts the NW provider to discuss admission
• Communicates with ED nursing staff that patient will be admitted
• Places the order Decision to Admit

• Completes the Admission Medication Reconciliation

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

• Calls report to NW RN

NW Provider

• 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
• Enters 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

• 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
• Communicates with OP Clinic/Charge RN
• Completes the Outpatient Medication Reconciliation

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
• Calls report to NW RN

NW Provider

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

• 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

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

• 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

• Evaluates patient to determine a disposition (admission or transfer back to LTC)
• Communicates with NW or LTC provider
  • See Admit from ED to NW (Inpatient) or Transfer from ED to LTC

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
• 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

• Evaluates patient to determine a disposition (admission or discharge)
  • See Admit from ED to NW (Inpatient)

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.

• 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