I’ve read some ED blogs commenting on transfers recently (well, when I started writing this post), and I’d like to add my two cents, as an EM doc working in a facility that accepts more than 2,000 transfers a year.

At my hospital the vast majority of transfer calls are fielded by the EM doc on duty, and it’s an interesting dance: listen to the physician who wants to send, determine if you have the resource the sending docs’ patient needs, and then make a decision if our receiving hospital can medically handle the patient being sent.  This includes a lot of facility-specific knowledge, not just the ‘on call’ list but our special capabilities that aren’t on the call list, etc.  Of course, this is just the “medical” part, then there’s the “Administrative” part, over which I have nor want any influence.

The rules about this are myriad and complex, and typically we err on the side of accepting a transfer.

A style point: if you’re trying to send a patient, start with “I have a patient who needs ENT, do you have that coverage” rather than the much more typical, “Mr. Smith is a 74 year old male with hypertension, diabetes and CHF…” because I will then cut you off and say ‘what do you need, and how can we help you’?.  This is a ‘Just the Facts Ma’am’ conversation, and should be short and sweet, respecting both our times.

And, the hard and ugly truth: transfers have allowed a lot of very dysfunctional hospitals to stay open, IMHO.  A hospital cannot get Ortho coverage (for example, not specific to bones), for the myriad reasons specific to that specialty?  Well, just transfer them to a hospital that does.  In this way, bad hospitals (administrators and medical staffs alike) aren’t confronted with their failures, their failures are transferred.  The inadequate hospital now doesn’t have to face angry patients and their families for their inability to manage their medical staffs, they just defer their responsibility to those who are just that: responsible.

I have told sending docs I would take their patient, but they had to go out and pry the word “Hospital” off their signs.  If it was you I was talking to……..I meant it.

Consultants and Transfers

If you’re a consultant doc to an ED, and the ED doc gives you a courtesy call that they’ve accepted a very critical patient for you to take care of, because a)you’re a doctor, b)it’s your specialty and c)you’re on call for that specialty, feel free to say “Thanks”, or even “OK”. A two minute tirade on how life is unfair, demonstrating that your mom obviously didn’t love you like your sibling, or that your undies are too tight isn’t really necessary. It is, in fact, painful and embarrasing to listen to, and we’re embarrased for you.

In fact, should you be a consultant in a system where the ED doc makes all the transfer acceptances, perhaps you’d like to change that system and take all the transfer calls for your specialty yourself, at all hours of the day or night, should you be on call. If not, perhaps you could act more like a professional, a physician and a colleague, and less like a spoiled child with a good vocabulary and a bad attitude. That’d be great, and everyone around you would be glad to work with you. The ED Doc would be glad to be out of the middle of that system, believe me.

So, you do your job, and we’ll do ours. Do your job without making ours painful, and we’ll help. Do your job with even a hint of a good attitude and we’ll go out of our way to help you out. We’re not your enemy, we’re ED docs.

also posted to LingualNerve