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  • Patient transfers between hospitals

    Do patient transfers between hospitals always have to be by ambulance? I've spent many a call night waiting on patients with surgical problems to be transferred from outside hospitals to ours so they can have their hip fixed, appendectomy, etc. Sometimes it takes hours and hours just to travel less than 100 miles in physical distance. Why not have a bare bones no thrill transfer service for stable patients? Like a hospital Uber. Ok forum tell me all the reasons why this is a bad idea!

  • #2
    I would think the possibility of patient demise during transport and the litigation that follows might have something to do with it.

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    • #3
      It seems like the only patients this would be suitable for are those who could take an Uber, in which case, why not stick them in an Uber?

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      • #4
        Emtala

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        • #5
          In residency we always trippled the distance. If the hospital was 1.5hrs away you knew 4.5hrs was a good estimate...
          Last edited by Otolith; 06-26-2021, 03:20 AM.

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          • #6
            Because if you had them take an Uber the private equity owned ambulance services couldn’t balance bill the patient for thousands of dollars. At least in the not so distant past. Good riddance.

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            • #7
              Sometimes having the patient drive themselves is a good idea, and sometimes it’s a disaster. And the problem is that you don’t know the patient at all beforehand so no way to make that determination. I’ve had patients come straight away and make it well before an ambulance would (and certainly cheaper for the patient), and others stop at home to feed animals, or eat dinner despite being instructed to not eat or drink anything and not show up for hours.

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              • #8
                No, not all patients need to be transferred via ambulance. Many of them don't need an ambulance. Many pediatric transfers don't need an ambulance if they have a normal guardian. However, the fear of litigation is so high amongst hospitals and many providers that it's just another unnecessary cost we tack onto the system.

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                • #9
                  the flip side of this is that i doubt that Uber at the level of the company or the individual drivers wants to be involved w/ anything that resembles a medical transport.

                  possibilities for litigation are endless

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                  • #10
                    verified nothing, but i had an uber driver (who claimed he used to own a cab company) tell me that they sometimes have teenager request rides after school without adults present. he claimed this was not legal but uber did not allow them to refuse rides despite this, and in his opinion wanted the drivers to keep doing this as they are the ones liable as “independent contractors.”
                    “. . . And the LORD spake, saying “First shalt thou take out the Holy 401k. Then shalt thou save to 20%, no more, no less. 20% shall be the number thou shalt save, and the number of the saving shall be 20%. 25% shalt thou not save, neither save thou 15%, excepting that thou then proceed to 20%. 30% is right out . . .””

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                    • #11
                      CMS does NOT consider private vehicle an appropriate mode of transportation for an EMTALA transfer.

                      However, three things come to mind:

                      1. Patients can elect to decline ambulance transportation. You can't force them to go by ambulance, but you must at least explain to them the risks and show that they have capacity to make an informed decision.

                      2. It is ultimately the responsibility of the SENDING facility to determine the mode of transportation. If you are the accepting physician, you can't be held liable by EMTALA standards.

                      3. CMS has applied EMTALA to many urgent cares and free-standing ER's for a lot of situations. This is why there is an uptick of ambulance transfers from urgent cares to ER's now.

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                      • #12
                        I drove for Uber/Lyft a ton during my fourth year of medical school, and still drive occasionally as a resident. When I was driving more often, I loved receiving requests from the hospital where I attended as a medical student. 99% of the time I would pull up, wait 5 minutes, contact the "rider" asking where they were, a nurse would answer telling me that they were "on their way down with the rider", Uber would request that I cancel the ride due to a no-show within five minutes and I would collect my $5-$10 in cancellation fees. Hospitals are not even equipped to transport a patient from the floor to the pick-up zone within Uber/Lyft's required time period. I can't imagine any hospital effectively setting up transfers between hospitals nonetheless. Who is going to bring the patient down? Can they get down in five minutes? Should the nurse assistant go down to the pickup zone first and then request a ride? What if the driver is 15 minutes away? Who is going to wait with Ms. Jones?

                        Additionally, as an uber/lyft driver, my responsibility was to transport riders from point A to point B, I am by no means responsible for helping you into or out of my vehicle, assisting with wheelchairs, devices, etc. Hospitals would be met with a ton of resistance from drivers if they realized that they were being involved in transports between hospitals of disabled riders. There are actually companies that have tried to fill a similar niche, I'm pretty sure one of them is something like GoGoGrandma or something weird like that. Every time I would receive a call from one of these companies the company based in some third-world country would nine times out of ten put in the wrong pickup location by a few miles. I think AI will take over radiology long before rideshare drivers are transporting hospitalized patients.

                        Also, any comment mentioning drivers being unable to cancel rides is completely untrue. I can cancel any ride at any point for any reason - given that I'm an independent contractor. Heck, to reference the post two above me, one of the options for cancelling a ride and still receiving compensation is, "Unaccompanied minor."

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                        • #13
                          “1. Patients can elect to decline ambulance transportation. You can't force them to go by ambulance, but you must at least explain to them the risks and show that they have capacity to make an informed decision.”

                          The whole ambulance business (there is a need) is filled with price gouging. Almost all are out-of-network, the patient has the right to decline and choose the destination.
                          Patients are NOT informed and pay for it. Like $2k.
                          https://www.houstonchronicle.com/new...e-15755042.php

                          And to think one could drive there in 10 minutes.
                          Feel free to complain about waiting time, try complaining about the bill.

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                          • #14
                            Originally posted by Tim View Post
                            “1. Patients can elect to decline ambulance transportation. You can't force them to go by ambulance, but you must at least explain to them the risks and show that they have capacity to make an informed decision.”

                            The whole ambulance business (there is a need) is filled with price gouging. Almost all are out-of-network, the patient has the right to decline and choose the destination.
                            Patients are NOT informed and pay for it. Like $2k.
                            https://www.houstonchronicle.com/new...e-15755042.php

                            And to think one could drive there in 10 minutes.
                            Feel free to complain about waiting time, try complaining about the bill.
                            CMS doesn't care about bills. If they did, they would police the unnecessary transfers (like the 20 year old we received the other day 9 hours after his traumatic subarachnoid hemorrhage). Discharged from the ER without ever seeing a neurosurgeon and without a repeat CT as per Brain Injury Guidelines. Unfortunately, you can't tell the sending facility that you won't accept if you have capacity. No matter how many times we say we follow BIG and it's our customary practice to send these patients home +/- repeat CT, they still insist on sending. Hopefully we can do some targeted education soon to get them comfortable doing this instead of wasting a bunch of money sending to us only to get 2 ER bills, an ambulance bill, and discharge home after a long transport.

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                            • #15
                              I'm sure we all see problems everyday in our practices that could and should be solved or worked on like the above transport issues, but instead of focusing on why we can and should do something, the government gets in the way and makes it impossible to change anything. Probably other industries besides healthcare have bureaucratic red tape too, but man is it frustrating to practice medicine in this environment.

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