Transfers to/from the ER

Redirect to:

• INTRA and INTERhospital Transfers

Admissions to Inpatient Unit

• We have 24-hour inpatient Family Medicine hospitalists who will admit all patients who require admission to the inpatient unit. They write the admission orders.
• When you determine that a patient would benefit from inpatient admission, have the med tech page the on-call inpatient provider for the appropriate village. Once the decision has been made for admission the inpatient 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.

Transfers Out

1. Call ANMC when you need to transfer a patient and ask for the appropriate service to consult for the transfer. For example, the surgeons take all trauma patients, the intensivists take all intubated patients, etc.
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. You must complete a paper consent for transfer, signed by you and the patient.
4. You must complete a paper PTO – Patient Transfer Order.
5. You must complete your transfer note – usually right before the team gets there so that the med tech can print out the chart to send along with the patient.
6. 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.
7. For patients who are traveling via commercial flight to Anchorage, the ER doc can authorize this travel if the patient does not have Medicaid or a means to pay for travel. See Preauthorized Travel

Critical Care Transfers between the Inpatient Ward and the ED

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.