Emergency Transfers from Nursing Home to Hospital
What really happens when a nursing home resident is rushed to the hospital? Emergency transfers can be chaotic and, if handled poorly, can lead to serious harm or even death. Families need to know what a safe and timely transfer should look like. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Jess Medina to talk about the laws, procedures, and best practices for emergency transfers from nursing homes to hospitals.
Medina:
As an ER nurse, I can see that nurse is in charge. This is their direct line. Okay, what’s going on? Let me get my questions answered that I have a nurse. As a nurse would act as another nurse, and then we can move on and have a lot less breakdown in communication and holes in the patient’s, either medical history or current condition.
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we are talking about the process by which. A resident who is in acute need of care makes it to a hospital. What is the process? How? How does the information in which the resident needs to be treated get from the nursing home to the hospital?
But we’re not having that conversation alone. We have the fantastic Jessica Medina. On the show to talk us through that process.
How do we do that? We’re not having that conversation alone. We have the fantastic Jessica Medina. Jessica is a dedicated RN with nearly 15 years of experience and a background in critical care ER trauma, and PAKU, which I had to just look up just now, which is post anesthesia care unit. For the past 18 months, she has served as a legal nurse, consultant and nurse expert combining her clinical expertise with a passion for advocacy outside of work.
She is a proud wife of a firefighter and a devoted mom to three young children. She finds fulfillment and using her nursing experience to make meaningful impact, and we are certainly happy for her to come on the show. Make an impact here with us today, Jessica. Welcome to the show.
Medina:
Hi. Thank you so much for having me.
Schenk:
I’m excited to talk to you because this is something that I get asked about a lot, like just the entire process from how the nursing home determines how they’re gonna, whether or not somebody needs to leave. And then once they determine they need to leave, how they get to where they’re going.
What steps are taken when a resident is transferred to a hospital?
So I guess the first question is what are the processes by which the nursing home decides to, and then. Transfers that resident to walk us through that from a general sense.
Medina:
Sure. So the emergency department really has no part in the actual setting up of the transfer that is the nursing home.
And it, from my understanding, it occurs when the nursing home recognizes that the resident needs a higher level of care. And the two different levels that it usually happens at is that if it’s an. Controlled the patient’s stable. Let’s get the patient to the emergency department. They’ll set up transport through a transport agency, and in my experience, the members of that transport agency are EMTs.
Usually two EMTs. They will get the patient loaded up, they will get report, and then the patient is transferred to the emergency department. The transport agency will contact the A base hospital, which is a. There’s a radio nurse who will get report. Okay, we know this patient is incoming to us. We get prepared for them.
What if the patient is in an emergency situation? Let’s say it’s the patient is in CPR status, or they’re not breathing, then the nursing home will call 9 1 1 an ambulance will come. Same idea the. The nursing home will provide the information, usually on a let’s go sort of basis. We need this stuff and we gotta run.
And then same thing, the transport agency, the ambulance will call the hospital, say, Hey, we’re on our way, this is what we have. And then as the emergency department will prepare for their arrival.
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Schenk:
I got so many notes. Okay. So typically when you’re receiving at the emergency room, when you’re receiving a resident that’s coming from a nursing home, you mention report.
Does someone from the nursing home accompany the resident to provide details?
Schenk:
So what do you, and I know every case is different, every nursing home is different, every hospital’s different. But typically, what is the report? Is it a physical piece of paper? Is it like, are they showing you an iPad with a screen? What? Tell, walk us through that.
Medina:
So it’s a little bit of all the above.
So the report that we get typically is gonna be from the transport agency, from the paramedic or the EMT. They will say once they get to the hospital let me back up a little bit. We’ll get notification. We have a 72-year-old female coming in for a fall with right hip pain. Okay? So we know what’s coming in.
That’s when. Then once the patient gets there, we’ll get report from the members of the transport agency and. What should be coming with them, which is our gold standard is what we call a transfer packet. That’s what we’ll have the paperwork that includes the patient’s wi wishes for, their advanced directive, their medications, allergies, preexisting conditions.
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And then we also get report from the medics or the EMT. Now, maybe I’m getting into a little bit of something more than what you asked, but typically, when we are transferring patient from one level of care to another, where nurses are involved, nurses give each other report, whether that’s at the bedside or on the phone, and I don’t know why, but that is not the case when it comes to receiving a patient from the nursing home.
We, as the emergency department, we don’t get a. From the nursing home, which can present with a lot of challenges while a game of telephone. The nursing home gives report to the transport agency who gives report to the ER. At Transport agency, they’re giving us a report based off a checklist of things that they need to know to get the patient from A to B.
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As a nurse, there are many times that we have questions about the patient that the transport agency either didn’t ask or they really aren’t concerned with. It’s not their priority, but we would’ve asked that from the nursing home staff. So many times we have to then call the nursing home, find somebody who’s in charge of the patient, which at many times it’s hard to get ahold of somebody there to get questions asked and answered, especially if that transport packet isn’t complete.
So to give you a long answer to that question that’s the process of getting a patient over and then getting report.
How does the nursing home ensure the hospital receives critical medical information, such as medications, allergies, and pre-existing conditions?
Schenk:
Okay. So the report is basically the EMS or the transport company’s description of what’s going on. Okay. Okay. Now, the transfer package as we’re calling it, in an ideal world.
What is in it? Is it Mars tars, like the face sheet? Like what, what all what? And if you have lived in the perfect world, you weigh, you weighed the Jessica’s magic wand. What’s in it?
Medina:
In my perfect world, we have either, a pulse or, and I don’t know if I can explain a little bit more what that is, but it’s a physician order.
I can think of physician’s order for a life sustaining treatment, which explains in detail what the patient wants if. Is an order for what the patient wants if they’re unable to say themselves, or an advanced directive a R. That includes the patient’s current list of medications, their medical history, current and past surgical history.
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A face sheet that in, or allergies as well. That’s another one. A face sheet that gives the name of their primary physician as well as a next of kin information, that’s huge as well. So that’s in our ideal world, or mine, at least what I would expect to be included in a transfer packet.
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Schenk:
And just for the audience out there, the fact that Jessica just rattled off what Pulses was the acronym?
Pulse without any hesitation? No. You know that she knows what she’s talking about because I been doing this for a while. Been a long time. Yeah.
Medina:
Since she had to say the real thing.
Schenk:
Okay, so here’s a dumb question, but something that I think should be answered is. Why, if you have a resident that seemingly from the report has fallen and maybe has a subdural hematoma, why does all that extra stuff matter?
Like, why would you need to know? Like just treat the per, maybe they got a their head is fractured. What else do you need to know?
Medina:
Oh, that is such a good question. Patients that come from nursing homes, many times they’re medically complex. There’s a lot of underlying health conditions and you can’t just take the patient.
This is true for many patients, but especially nursing home patients, is you cannot. Just take the presenting picture. You really have to do some investigating of what else is going on. So for example, what you just said, this patient came in with a fall, they possibly have a subdural. That is very true and that should be treated immediately.
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Why does this patient, okay, this patient also has a fever. They’re a little bit hypotensive. They fell because they got out of bed when they don’t normally get outta bed. Okay. What’s going on? In their history, we see this patient has a history of A UTI or this patient was currently being treated for UTI and as we know.
Older patients, when they develop a UTI will at times present, confused. That’s why this patient has a fever. This might be why this patient also is hypotensive. Okay? Are we thinking also sepsis that also contributed to this fall? So we really need the whole picture in order to take care of this patient.
Also to know, hey, is this patient on blood thinners? Because that could very well change the treatment, not necessarily treatment, but the course of the treatment.
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Schenk:
How often is it that, and at least in your experience, that you get, not the perfect transfer package, but anything in the transfer package from a long-term care facility?
Medina:
I would say that it is almost always that we get a transfer packet. The problem is that not being completed and I. Oh man, 50 to 75% of the time is it completed to what I would expect it to be completed as to have all the things that we need where we don’t have to then call the facility, we need this, or this is outdated, or this post isn’t signed.
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Schenk:
So what’s, okay, so this would be a good, okay, so now you’re, this is a public service announcement from Jessica to the nursing homes. So what is it typically lacking? What are the things when you’re like, when you’ve got the transfer package, you’re like, oh, s like why don’t I don’t have this typically what is it and what if you’ve got all the nursing, you got all the nursing homes listening what would you tell them?
Medina:
The, in my. The number one most important thing to me is to have a signed pulse because if that is not signed, then it is not valid. We need to have enough to up to date signed pulse, make sure that is the most recent, not an old one, that it is signed because that drives the rest of our treatment. We need to know, and we want to honor what these, what this patient’s wishes are ensuring that is signed.
We want to know what medications are on. They’re on. What their medical history is. Make sure that is in there so that we have a full picture of what this patient looks like before they get to us. Not a full picture, but a good idea. And then having a next of kin or a power of attorney’s information that we, so that we can be in contact with them, especially if this patient isn’t able to communicate on their own.
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Where do communication breakdowns typically happen during hospital transfers?
Schenk:
So I would consider the lack of having complete transfer package, a breakdown in communication. Where else would you consider in your experience, the breakdown in communication between the nursing home and the receiving hospital? Like, where else are we having problems?
Medina:
The transfer packet being done in its completion, but I also think that the fact that the nursing home practice isn’t.
To speak directly to the nurse. Caring for that resident is a huge breakdown. In any other situation where the nurse is transferring a patient to another area of the hospital where there’s another nurse, we give reports. And granted, there is, there are some challenges when a nurse, when a patient is leaving a nursing home to the hospital.
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We, they don’t know exactly what room, so to speak, or what nurse at the ER will be caring for that patient. So that makes it hard for the nursing home to call when the patient leaves and say, Hey, can I talk to nurse so-and-so in the er? They don’t know who it’s gonna be, but if there would be some sort of process that could be in place where on that transfer packet, it’s stated nurse so and this is their direct number.
Call them when patient arrives to get a direct report. I would be extremely helpful so that as an ER nurse, I can see that nurse so and so is in charge. This is their direct line. I have my patient now. I’ve got them settled. I’m calling to get a report, to get an idea of, okay, what’s going on? Let me get my questions answered that I have a nurse, as a nurse would ask another nurse and then we can move on and have a lot less.
Breakdown in commun communication and holes in the patient’s, either medical history or current condition.
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Schenk:
Is it ever the case that the nursing home c calls the hospital? Like in your experience, like a affirmatively okay, we’re, hey, we’re sending somebody here. We didn’t have time to give the EMS people a report, et cetera.
Does that typically happen? No,
Medina:
I have never come across that. It’s the standard process is the nurse. Transporting agency to us. And what’s interesting is that, and it’s always been my standard practice, I don’t truly know if it’s a policy in our hospital, but it’s always been my standard practice is that when, if the res, if the patient is leaving to go back to the nursing home, let’s say, they don’t need to be admitted, I always call the nursing home and I ask to speak to the nurse that’s taking care of that patient, if that’s speak.
Typically it’s a very quick report. Hey, we saw so and these are the medications that we gave. These were their last set of vitals. This was what we found or didn’t find. They left at this time, they’re heading back to you and if we’re doing that on our end so that we’re closing the loop.
On what was done on this patient so that they know who they’re getting back and what they’re getting back and what happened to that resident. Then it should be working the other way around. We should be getting as an emergency room, a report from the nurse or the caretaker at the nursing home.
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Schenk:
What are some problems, and this, as you, I think you described this probably perfectly as the telephone game.
What are some problems that are occurring between the facility, the nursing home and the transport agency, and then from the transport agency to, to you? Like where are you seeing problems there?
Medina:
The transport agency, they’re really great at doing what they need to do and getting the questions that they need answered.
Again, to get the patient from point A to point B. The problem is then when I have a, as a nurse, have a question of, Hey, did you know if this patient got this medication? Or do you know if this patient is still being treated for this? And the EMS is I don’t know, that’s not on their radar to ask.
It’s on mine as the nurse and it’s a nursing brain sort of question that if the nursing home were to call to give report and I were to talk to that nurse, they would be able to answer that. They’d be expecting that question. Whereas a transport agency, again, they have their list and they don’t really veer from that, which is fine.
They don’t really need to, it’s not their job.
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Schenk:
So let’s imagine that you’ve got a KY. Transport report. Like a, what did we say? Transfer sheet. What’s the name that we said? What is it called? What are we calling it?
Medina:
So we call it I, and I’ve probably been saying it interchangeably, but either a transfer packet or a transport packet.
How can families ensure their loved one’s needs are properly communicated during a transfer?
Schenk:
The packet, either one. That was the word I lost. The trans, the transfer packet. So let’s say you got a janky transfer packet. Okay. But it has the next of can the residence representative. The family member, and you call them. Okay. What are some things that you can tell that person? That might help this transfer process.
In other words, like it might be like, Hey, do you have a pulse? Do you have, whatever you might be missing. Maybe they have it. Like what? What are some things that you would recommend that, some actions that they could take in anticipation of potentially being in this position one day?
Medina:
There is, in my mind, besides the perfect transfer packet, nobody better than a family member who’s involved in their loved. My advice would be for any next of kin that you make it very clear to the nursing home that if your loved one is ever being transferred anywhere, including the emergency department, that you want to be notified that their loved, that your loved one is, has been transferred and that you know where they’re being transferred to.
While it’s not possible for everybody, if it is possible to come to the emergency department, we. Love having family there. They are so helpful in answer questions. Just being with their loved one. Our patients do better when they have family there. They feel more comfortable. If that’s not possible, finding the name of the emergency department that the patient went to, give us a call.
Let us know. Say, Hey, my loved one is either there or they’re coming. This is my name. This is my phone number. Please call me with any questions and with any updates and besides the nursing home. That is our first call. We call, Hey, it says this. Are they still taking this medication or were you aware that they were being treated for a UTI?
Have they had it in the past? Do they normally get confused? Just being able to have that open dialogue with a patient’s family who knows them best is huge.
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Schenk:
Very well said. Jessica, we really appreciate you very much coming on the show and sharing your knowledge with us.
Medina:
Thank you so much for asking me. It was a pleasure.
Schenk:
Folks, I hope that you have found this episode educational. If you did, please be sure to like and subscribe wherever you get your podcast from. If you have an idea for a topic that you would like for me to talk about, let me know. If you have a suggestion for someone that you would want me to talk to, please let me know that as well.
Please make sure to do whatever it takes to get this stupid mug. New episodes of the Nursing Home Abuse podcast come out every single Monday, and with that folks. We’ll see you next time.
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