Patient Transfers

Patient transfers can be defined by the various methods (e.g., ground or air transport) and motives (e.g., transfer to another hospital because the patient does not have health insurance) for moving a patient from one location to another. A major classification of patient transfers is whether they are intrafacility or interfacility transfers. Intrafacility transfers are patient transfers within a given healthcare facility, either between departments or between other organizations within the healthcare facility. In contrast, interfacility transfers are patient transfers from one healthcare facility to another facility. Examples of interfacility transfers include the following: (a) hospital-to-hospital transfers, (b) clinic to hospital transfers, (c) hospital to rehabilitation facility transfers, and (d) hospital to long-term care facility transfers.

Challenges to the success of interfacility transfers include the qualifications of those delivering the care, the ability to meet the clinical needs of the patient, and the aptitude to maintain continuity of care. Due to the emergence of specialty medical systems such as cardiac centers and stroke centers, the ultimate destination of a patient is now often predicated on the patient's specific medical condition rather than the proximity of the nearest medical facility. This practice has created the need for enhanced measurement and guidelines and the evaluation of patient transfers to understand and track the different circumstances under which transfers take place.

Because of this change, the number of stakeholders involved in patient transfer protocols and instrumentations has increased and diversified over the past few years. Stakeholders include physicians at both the receiving and transferring facility, the medical staff of both institutions, the patient and the patient's family and caregivers, the third-party insurance groups, the health administration and legal staff of both facilities, and the transferring bodies such as the ambulance staff. Additional stakeholders include Emergency Medical Services (EMS) organizations and the National Highway Traffic Safety Administration (NHTSA) who enter into discussions to create EMS priority issues and [Page 906]establish guidelines for the EMS organization's critical-care transport. This level of transport care is provided to patients whose indication requires an expert level of provider knowledge and skills, a setting with necessary equipment, and the ability to handle the challenge of the transport.