Harbor:Incoming transfers - Revision history

Kwilhelm: /* Overview */

2025-11-15T17:07:50Z

Overview

← Older revision		Revision as of 17:07, 15 November 2025
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	**If Catalina Island has a 911 Trauma Retriage, they will contact Harbor Base for an accepting physician and will be responsible for coordinating air transport. If the patient does not met 911 Trauma Retriage Criteria, they should coordinate the transfer through the MAC.		**If Catalina Island has a 911 Trauma Retriage, they will contact Harbor Base for an accepting physician and will be responsible for coordinating air transport. If the patient does not met 911 Trauma Retriage Criteria, they should coordinate the transfer through the MAC.
	***[https://file.lacounty.gov/SDSInter/dhs/206268_520.pdf LA County DHS Protocol 520]		***[https://file.lacounty.gov/SDSInter/dhs/206268_520.pdf LA County DHS Protocol 520]
	***[https://file.lacounty.gov/SDSInter/dhs/1030597_5201AHMTransferProcess.pdf Catalina Island Transport Algorithm]		***[https://file.lacounty.gov/SDSInter/dhs/1030597_5201AHMTransferProcess.pdf Catalina Island Transport Algorithm DHS 520.1]
	** If Catalina Island has a psychiatric patient requiring transport to Harbor, the Catalina physician will contact MAC to help facilitate the transfer to Harbor-UCLA. If the patient is a pediatric patient or requires medical clearance, MAC will involve an adult or pediatric attending as appropriate for acceptance.		** If Catalina Island has a psychiatric patient requiring transport to Harbor, the Catalina physician will contact MAC to help facilitate the transfer to Harbor-UCLA. If the patient is a pediatric patient or requires medical clearance, MAC will involve an adult or pediatric attending as appropriate for acceptance.
	***[https://lacounty-my.sharepoint.com/:b:/g/personal/kwilhelm_dhs_lacounty_gov/Ed_W_ZaIfmpNv7CyrXpnCVsB4naIUFs5q8uT9wYSWoLXKg?e=MNbkEX Catalina Island Psych Transfer to Harbor Protocol]		***[https://lacounty-my.sharepoint.com/:b:/g/personal/kwilhelm_dhs_lacounty_gov/Ed_W_ZaIfmpNv7CyrXpnCVsB4naIUFs5q8uT9wYSWoLXKg?e=MNbkEX Catalina Island Psych Transfer to Harbor Protocol]

Kwilhelm: /* Overview */

2025-11-15T17:04:42Z

Overview

← Older revision		Revision as of 17:04, 15 November 2025
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	==Overview==		==Overview==
	There are generally four types of transfers that come into the emergency department:		There are generally four types of transfers that come into the emergency department:
	*'''STEMI ~~911~~''' and '''Trauma ~~911~~''' Transfers		*'''911 STEMI Retriage''' and '''911 Trauma Retriage''' Transfers
	** From nearby EDs that are not Trauma Centers or STEMI centers		** From nearby EDs that are not Trauma Centers or STEMI centers
	** Ensure we are "open" to trauma and STEMI patients (ask the MICN), and activate the appropriate resources within our facility		** Ensure we are "open" to trauma and STEMI patients (ask the MICN), and activate the appropriate resources within our facility
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	* Transfers should be ED to ED; if there are extenuating circumstances where an inpatient requires transfer to Harbor ED, do what is in the best interest of the patient; the DEM Chair will happily provide advice or address any questions/concerns 24/7		* Transfers should be ED to ED; if there are extenuating circumstances where an inpatient requires transfer to Harbor ED, do what is in the best interest of the patient; the DEM Chair will happily provide advice or address any questions/concerns 24/7

			*'''Catalina Island Transfers'''
			**If Catalina Island has a 911 Trauma Retriage, they will contact Harbor Base for an accepting physician and will be responsible for coordinating air transport. If the patient does not met 911 Trauma Retriage Criteria, they should coordinate the transfer through the MAC.
			***[https://file.lacounty.gov/SDSInter/dhs/206268_520.pdf LA County DHS Protocol 520]
			***[https://file.lacounty.gov/SDSInter/dhs/1030597_5201AHMTransferProcess.pdf Catalina Island Transport Algorithm]
			** If Catalina Island has a psychiatric patient requiring transport to Harbor, the Catalina physician will contact MAC to help facilitate the transfer to Harbor-UCLA. If the patient is a pediatric patient or requires medical clearance, MAC will involve an adult or pediatric attending as appropriate for acceptance.
			***[https://lacounty-my.sharepoint.com/:b:/g/personal/kwilhelm_dhs_lacounty_gov/Ed_W_ZaIfmpNv7CyrXpnCVsB4naIUFs5q8uT9wYSWoLXKg?e=MNbkEX Catalina Island Psych Transfer to Harbor Protocol]

	*EMTALA or '''Higher Level of Care''': we accept these as long as we are not in Surge status.		*EMTALA or '''Higher Level of Care''': we accept these as long as we are not in Surge status.

Kwilhelm: /* Clinic Referrals to ED */

2025-11-15T16:53:04Z

Clinic Referrals to ED

← Older revision		Revision as of 16:53, 15 November 2025
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	Also, depending on the complaint, I give the clinic doctor a rough estimate of the time the patient will wait to be seen. (Clinic patients do not necessarily get priority over other patients that are waiting in the waiting room, who may be sicker.) I ask the clinic doctor to advise the patient of the possible wait so they can make an informed decision about coming to the emergency department. (They may want to go elsewhere if we are highly impacted.) This hopefully helps prevent the clinic doctor from falsely informing the patient that they will seen "right away".		Also, depending on the complaint, I give the clinic doctor a rough estimate of the time the patient will wait to be seen. (Clinic patients do not necessarily get priority over other patients that are waiting in the waiting room, who may be sicker.) I ask the clinic doctor to advise the patient of the possible wait so they can make an informed decision about coming to the emergency department. (They may want to go elsewhere if we are highly impacted.) This hopefully helps prevent the clinic doctor from falsely informing the patient that they will seen "right away".
	If the clinic is one of our in-house clinics at Harbor (these calls are often taken by the senior resident), in order to maintain good working relationships with other hospital services we request that there be attending involvement if a decision is made to send such a patient to wait in the waiting room. This decision should be documented in the EHR the same way we document ambulance patients sent out the waiting room. We don't have a rule that states clinic patients jump to the head of the line; you are free to use your judgment, as again there may be sicker patients in the waiting room. Do consider however that this patient has in essence already been triaged by a (clinic) physician in most cases.		If the clinic is one of our in-house clinics at Harbor (these calls are often taken by the senior resident), in order to maintain good working relationships with other hospital services we request that there be attending involvement if a decision is made to send such a patient to wait in the waiting room. This decision should be documented in the EHR the same way we document ambulance patients sent out the waiting room. We don't have a rule that states clinic patients jump to the head of the line; you are free to use your judgment, as again there may be sicker patients in the waiting room. Do consider however that this patient has in essence already been triaged by a (clinic) physician in most cases.
	Special note: transfers from the hospital in the city of Avalon on Santa Catalina Island are generally viewed as referrals from a clinic, so we normally accept them without question due to their extremely limited facilities on the island. These transfers almost always come by helicopter.

	Dir OPS 1/9/17		Dir OPS 1/9/17


	==See Also==		==See Also==

Andreawu: /* Overview */

2022-09-12T18:21:18Z

Overview

← Older revision		Revision as of 18:21, 12 September 2022
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	***The Patient Flow Facilitator determines if we have the right bed type available		***The Patient Flow Facilitator determines if we have the right bed type available
	**The ED Attending must make sure the ED has safe capacity		**The ED Attending must make sure the ED has safe capacity

			*ED attending writes pre-arrival note when accepting any transfers.
			*ED attending informs area charge of patient to help prepare bed
			**Please also alert the router if a pre-arrival will be arriving by private car.

	==The usual process==		==The usual process==

Bchap23: /* Overview */

2019-02-08T19:39:11Z

Overview

← Older revision		Revision as of 19:39, 8 February 2019
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	==Overview==		==Overview==
	There are generally four types of transfers that come into the emergency department:		There are generally four types of transfers that come into the emergency department:
	*"STEMI 911" and "Trauma 911" Transfers ~~- these are transfers from other emergency departments in our area~~ that are not Trauma Centers or STEMI centers. Since we are both a Trauma Center and a STEMI center we have agreed to take urgent transfers from other emergency departments if they feel their patient needs these services. The sending facility may contact you directly. We rarely say "no" to these cases as long as we are "open" to trauma and STEMI patients (ask the MICN~~/Radio Nurse or Charge Nurse about our status~~), ~~and just take information~~ and activate the appropriate resources within our facility. The sending facility is responsible for calling EMS and arranging for the emergent transfer. Note: these transfers are from the emergency department, and should not be from the inpatient units of the sending hospital.		*'''STEMI 911''' and '''Trauma 911''' Transfers
			** From nearby EDs that are not Trauma Centers or STEMI centers
			** Ensure we are "open" to trauma and STEMI patients (ask the MICN), and activate the appropriate resources within our facility
			** The sending facility is responsible for calling EMS and arranging for the emergent transfer.
			** Note: these transfers are from the emergency department, and should not be from the inpatient units of the sending hospital.

	* Transfers should be ED to ED; if there are extenuating circumstances where an inpatient requires transfer to Harbor ED, do what is in the best interest of the patient; the DEM Chair will happily provide advice or address any questions/concerns 24/7		* Transfers should be ED to ED; if there are extenuating circumstances where an inpatient requires transfer to Harbor ED, do what is in the best interest of the patient; the DEM Chair will happily provide advice or address any questions/concerns 24/7

	*EMTALA or "Higher Level of Care": we ~~consider accepting~~ these as long as we are ~~open to "EMTALA Transfers" - check with the charge nurse. Depends on our~~ Surge status. ~~In order for~~ us ~~to accept these transfers from other emergency departments~~, they ~~must~~ be approved by ~~all of the following~~:		*EMTALA or '''Higher Level of Care''': we accept these as long as we are not in Surge status.
	**The subspecialty service that will likely be involved in the care of the patient ~~(they determine if they have the right personnel and equipment to care for the patient.)~~ The trauma service may serve as approval authority for ~~all~~ surgical patients~~, whether trauma or not.~~		** Prior to us accepting the patient, they should be approved by:
	**The Patient Flow Facilitator ~~("PFF" - he or she~~ determines if we have the right bed type available ~~- the bed must be currently open)~~		*** The subspecialty service that will likely be involved in the care of the patient
	**The Emergency Department (we determine if we are uncrowded enough to safely take another patient). A general approach is to look at how many ESI 2 patients are waiting to be seen, and how far backed up we are with triaging, and to a lesser extent how many total patients are waiting to be seen.		***The trauma service may serve as approval authority for ALL surgical patients
			***The Patient Flow Facilitator determines if we have the right bed type available
			**The ED Attending must make sure the ED has safe capacity

	==The usual process==		==The usual process==

Rossdonaldson1: Text replacement - "Harbor:Operations manual" to "Harbor:Main"

2019-01-31T07:26:36Z

Text replacement - "Harbor:Operations manual" to "Harbor:Main"

← Older revision		Revision as of 07:26, 31 January 2019
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	==See Also==		==See Also==
	*[[Harbor:~~Operations manual~~]]		*[[Harbor:Main]]

	==References==		==References==

Rossdonaldson1 at 22:15, 7 January 2019

2019-01-07T22:15:28Z

← Older revision		Revision as of 22:15, 7 January 2019
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	==References==		==References==
	<references/>		<references/>

			[[Category:Admin]]

Rossdonaldson1 at 21:57, 7 January 2019

2019-01-07T21:57:55Z

← Older revision		Revision as of 21:57, 7 January 2019
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	Dir OPS 1/9/17		Dir OPS 1/9/17


			==See Also==
			*[[Harbor:Operations manual]]

			==References==
			<references/>

Rossdonaldson1: /* Clinic Referrals to ED */

2019-01-07T21:57:26Z

Clinic Referrals to ED

← Older revision		Revision as of 21:57, 7 January 2019
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	**Items are not to be left on top of the gurney		**Items are not to be left on top of the gurney

	===Clinic Referrals to ED===		==Clinic Referrals to ED==
	Occasionally you will get a call from a clinic either directly or through MAC to "transfer" a patient. These are not considered transfers under EMTALA, and should be considered simply "referrals". Clinic physicians can refer their patients wherever they like; we can't really "refuse" these patients. It's recommended that you listen to the clinical situation, advise the clinic doctor on whether or not the emergency department visit is likely to be helpful for the situation, and advise the clinic doctor if you think the patient needs to come by ambulance. In the end all of these decisions belong to the clinic physician.		Occasionally you will get a call from a clinic either directly or through MAC to "transfer" a patient. These are not considered transfers under EMTALA, and should be considered simply "referrals". Clinic physicians can refer their patients wherever they like; we can't really "refuse" these patients. It's recommended that you listen to the clinical situation, advise the clinic doctor on whether or not the emergency department visit is likely to be helpful for the situation, and advise the clinic doctor if you think the patient needs to come by ambulance. In the end all of these decisions belong to the clinic physician.
	Also, depending on the complaint, I give the clinic doctor a rough estimate of the time the patient will wait to be seen. (Clinic patients do not necessarily get priority over other patients that are waiting in the waiting room, who may be sicker.) I ask the clinic doctor to advise the patient of the possible wait so they can make an informed decision about coming to the emergency department. (They may want to go elsewhere if we are highly impacted.) This hopefully helps prevent the clinic doctor from falsely informing the patient that they will seen "right away".		Also, depending on the complaint, I give the clinic doctor a rough estimate of the time the patient will wait to be seen. (Clinic patients do not necessarily get priority over other patients that are waiting in the waiting room, who may be sicker.) I ask the clinic doctor to advise the patient of the possible wait so they can make an informed decision about coming to the emergency department. (They may want to go elsewhere if we are highly impacted.) This hopefully helps prevent the clinic doctor from falsely informing the patient that they will seen "right away".

Rossdonaldson1: /* Responding to a Helicopter Landing */

2019-01-07T21:57:17Z

Responding to a Helicopter Landing

← Older revision		Revision as of 21:57, 7 January 2019
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	Dir OPS 1/9/17		Dir OPS 1/9/17

	===Responding to a Helicopter Landing===		==Responding to a Helicopter Landing==
	*Requires 2-3 trained individuals, does NOT require a physician, though one may elect to go.		*Requires 2-3 trained individuals, does NOT require a physician, though one may elect to go.
	*Only individuals with helicopter safety training should respond to a helicopter landing.		*Only individuals with helicopter safety training should respond to a helicopter landing.