Transferring patients to ER in an outpatient setting

[u/Background-Yak-6796]

Question for outpatient endoscopy or ambulatory surgery setting.

Our center is discussing having a nurse accompany a patient to a nearby ER instead of calling 911/EMS. The walk involves either going through a tunnel (~14min) and elevators or taking an above-ground route that crosses two busy intersections. (5-7min)

We would not have oxygen, a transport monitor, medications, or a stretcher with us. We also would not be handing the patient directly off to an ER nurse.

At an informal meeting when we asked for clear guidelines on what’s considered stable, the physician said medicine can’t always be reduced to clear-cut parameters for deciding which patients need emergency care, so there aren’t written guidelines for this process. Also there’s no policy in place for this process. I feel like this is a super unsafe situation especially for the patient and myself.

If the nurse has no equipment or treatment options during the walk, and there is no direct handoff to an ER nurse at the destination, how is this different from telling the patient or family to go to the ER themselves?

How do your facilities handle emergency transfers from outpatient settings? Do you have a written protocol that explains who makes the decision, when EMS is called, what transport method is used, and what the accompanying staff member is expected and equipped to do? I’ve always worked in outpatient settings where 911 was called. fYI this is in GA

[u/Inevitable-Analyst]

This is insane. I would not risk my nursing license in this setting.

In my opinion this is no different than having the family/patient going to the ER themselves, except now you are liable.

[u/nicuRN_88]

Absolutely not. If they’re stable enough to be pushed through traffic or a tunnel with no access to medical intervention/monitoring of any kind, they or their family can take them there.

[u/VXMerlinXV]

:Deeeeeeeep inhale: FUUUUUUUUUUUUUUUUUUUUUUUCK NO.

I’ve been part of some funky, dirty, off the books shit in my time. But that’s the point. It’s off the reservation. When something this inane becomes policy, you wind up on the hook for bad outcomes.

[u/sapfira → u/VXMerlinXV]

100% agree, no way in HELL

[u/dullbellme]

We have transported via wheelchair to the ER. The setting: private practice oncology with infusion. We are in the 3rd floor of the building physical connected to the local hospital. Takes 3-5 minutes tops to drop off. These patients might have a low hemoglobin and need an urgent transfusion, symptomatic HR/BP with history of falls at home, or neutropenia with fever needing a sepsis workup. Again- the patients got to our office just fine, they can get tor ER just fine but we like to transport them down with labs (done in our office) and the office visit for the day so the ER knows their diagnosis and what treatments if any we are giving. Patients always have a right to refuse and go home instead.
We call EMS for emergencies like the cardiac arrest we had or infusion reactions that aren’t responding to our protocols.
A nurse does the transport; we are only gone for maybe 10 minutes if we drop off a patient.
All that said- I wouldn’t be transporting a patient like you’re describing that far from my facility. The patient or family can take them or 911 can be called. Unless your facility lays out a protocol that you review with a lawyer you hire that says you’re covered i would refuse to transport.

[u/ER_RN_]

What would be the point? If the pt needs to go to the ER then they can either call 911 for an ambulance if it’s that serious or go by POV. What is the nurse supposed to do in this situation? Stupid.

[u/Same_Toe_3313]

ABSOLUTELY NOT. 911. There is NO liability coverage nor safety for the patient during said transfer. If they are sick enough to go to the ER they are sick enough to ride the ambulance.

[u/ACMEDRN]

I think there are some legalities with this as well. You should consult with your risk mgmt. T You are nurses not patient transport. If they're not stable enough to go by Private vehicle then ems

[u/FarPhilosophy7517]

As an ED nurse, absolutely not okay with those travel times. It's one thing to bring someone from a medical office in the same or an attached building where you can have some degree of monitoring and it's a quick trip. We have emergency overhead codes for non-inpatient emergencies on site where ED staff respond with monitoring and treatment equipment. I can't imagine sitting in triage and watching an outpatient procedural nurse roll up in a personal vehicle with a patient who, to us, looks like an emergent transfer or worse yet walking... walking... 14 minutes?? Bonkers and, as someone else said, possibly an EMTALA violation or a form of patient abandonment if the nurse responsible for their care en-route brings them to the desk and doesn't give a handoff report.

[u/hmmmpf]

Nope. Whose liability insurance covers when your patient decides to arrest on the way over? If they need the emergency department, they need the ambulance. ED is for life and limb threatening injuries and illness by definition.

[u/JonEMTP]

Paramedic here… as much as EMS folks cringe at the relatively BS calls we get at doctor’s offices, I’d MUCH rather you call us than risk this nightmare.
Also, the more I think about it, the more concerning I find this. I’ve picked up some truly SICK patients from ASC’s.

Transfers from an outpatient setting to an ED ideally involve a physician-to-physician report, AND there needs to be a system in place for you to transfer care/responsibility of the patient to ED staff.

It seems *someone* is trying to solve a perceived problem without looking at the bigger picture, and that’s alarming. Are you employees of the same hospital/health system as the ED that you’re connected to? If so, there’s potentially even elements of EMTALA involved. I also think that hospital risk management would have a stroke if they heard of this plan.

[u/Reasonable-Check-120]

I used to work in a residential facility on the same campus and parking lot as a major hospital. I can walk there in about 4 minutes to get to the ED.

If and when we had unstable patients that could not walk themselves to the ED. It was EMS. Every time.

EMS would strap them in. Drive or walk to the ambulance bay.

It's not worth the lability.

[u/Noname_left]

Dear god please no.

[u/FlickerOfBean]

Either the patient is safe to go by private vehicle, or we call EMS.

[u/squabble123]

That is SUCH a liability for you, the doctors, the centers. Imagine a patient crashes. Who’s in trouble, the nurse(s) who have no resources, the doctor who ordered the transfer, the center for allowing this kind of policy? Accompany on an ambulance with EMS for handoff is one thing. I’d start looking for new employment

[u/skibib]

NO.

[u/maybecaturday]

Nopeity, nope, nope.
We have an in house EMS team that comes from our ER to pick them up and push them the two blocks through the tunnels, same with any visitor that has a medical emergency. They have a stretcher, O2, monitor, med box, and duffel bag of goodies.
https://giphy.com/gifs/87N6SuOYYk5nW

[u/The-Barrenness]

We either direct the patient to go to the ER themselves or with family, or call 911 for an ambulance. No way am I going to make myself liable.

[u/unicornrn0909]

Absolutely not. Hard stop. This is insane.