Patient care is complex. Not all hospitals are equipped to provide the types of care that every patient requires. Even within the same facility, patients often require transfer from one unit to another as their condition changes.
Whatever the case, how can you ensure patients are transferred safely?
Facilities can ensure that their patients are safely transferred when following guidelines for detailed planning, documentation, and communication.
In this article, we will explore:
- Best practices when doing patient transfers
- Common reasons for hospital transfers
- Risks and pitfalls of not doing transfers right
- Legal requirements for transfers
- Tips for your facility to optimize care and safety
As a facility administrator, you want what’s best for your facility. Keep reading to learn how to make your facility succeed in the long term.
What is a hospital transfer?
A hospital transfer is the movement of a patient from one care setting to another.
A patient transfer can occur between units or departments within a single facility (intrahospital transfer). However, they can also happen between 2 different facilities (interhospital transfer).
This whole process involves:
- Detailed planning
- Proper documentation
- Effective communication
Hospital transfers are critical because not all facilities or units are equipped to provide every level of care. Patients may arrive at hospitals that lack the specialized staff, technology, or resources required for their condition, or their clinical needs may change rapidly during treatment.
What are the risks of not doing a transfer?
When transfers to the appropriate level of trauma care are delayed or poorly coordinated, patients face increased risks, including treatment delays, clinical deterioration, and preventable harm.
- Clinical deterioration: Patients with time-sensitive conditions (such as sepsis or stroke) can rapidly decline and even die if not transferred to a specialized unit in time.
- Medical complications: Untreated diseases can lead to short- and long-term complications. Not transferring a patient in time can increase the odds of permanent disability and organ damage.
- Financial implications: Delayed treatment increases costs, strains resources, and can lower patient satisfaction scores.
Integrate transfers into your emergency operations plan to avoid these risks.
3 Common reasons for hospital transfers
Why and when should a patient be transferred?
A hospital transfer should happen when there is a clinical, logistical, or patient-driven need. These are the 3 most common reasons for a patient transfer.
1. Specialized treatment needs
Often, a patient transfer happens for specialized procedures that another unit or facility provides. For example:
- Organ transplant
- Advanced burn care
- Ventilator care
2. Changes in a patient’s acuity
Transfers also occur when the patient needs to increase or decrease the complexity of care required.
- Acuity decrease: Transfer from a critical care unit to a step-down unit
- Acuity increase: Transfer from a medical-surgical unit to intensive care
3. Patient request
Can a patient request a transfer to another hospital?
Yes. Patients can request transfers to another hospital. Some common reasons include:
- They want familiarity
- They wish to be closer to home
- They feel dissatisfied with their current care
The Centers for Medicare & Medicaid Services (CMS) mandates that, when a patient requests it, they should be transferred, as long as the desired hospital can provide the care they need and has space for the patient.
Note that there are cases in which a transfer might worsen the patient's condition, making a patient transfer unwise.
Types of patient transfers
Patient transfers can be categorized as primary, interhospital, or intrahospital.
Legal and regulatory requirements for patient transfers
If you want to protect yourself and your patients, you need to navigate hospital transfer regulations carefully:
- EMTALA requirements: The Emergency Medical Treatment and Labor Act (EMTALA) mandates that all hospitals screen and stabilize all patients before any transfer.
- CMS enforcement: Facilities must maintain detailed transfer documentation, including medical records, certification of stability, and acceptance from the receiving hospital.
- Reporting requirements: In the case of an unstable transfer, facilities may be required to report the incident to CMS and face regulatory review.
Failing to meet these requirements and mandates may result in fines, lawsuits, scrutiny, and exclusion from Medicare for the facility.
Prevent unsafe hospital discharges while transferring patients to avoid any complications for your patients, your clinicians, and your facility.
Hospital patient transfer protocol
How to transfer a patient from one hospital to another?
When designing your transfer policies, make sure that you have a hospital patient transfer protocol in place with a sequence similar to the following:
- Assess and stabilize: Evaluate patients and address life-threatening conditions first.
- Consult physicians: Ensure that a physician agrees with the transfer.
- Get patient consent: Get family consent if patient consent is not possible.
- Prepare and document: Use a transfer checklist to avoid documentation and medication errors.
- Transport safely: Use equipped vehicles and an escort for interhospital transfers.
- Conduct a proper handoff: Ensure a complete verbal and written handoff report is conducted.
There is significant nurse responsibility in patient transfers, as nurses often lead coordination and help to reduce errors.
Patient transfer checklists
Your facility can benefit from a patient transfer checklist. It can help all clinicians involved ensure that the transfer documentation is in place and nothing is overlooked.
A checklist that will help you align with safe patient transfer protocols could look like this:
Checklist for interhospital transfers
Answer these questions with simple checks:
- Is the patient stabilized?
- Is physician acceptance confirmed?
- Have all records been sent?
- Has the family been notified?
- Is there a trained escort for the transfer?
- Has the equipment for the transfer been checked?
Checklist for intrahospital transfers
Answer these questions with simple checks:
- Are the ID bands verified?
- Is there a list of allergies and medications?
- Are lines and tubes secured?
- Have vitals been checked?
- Is the receiving unit ready for the patient?
5 Tips to improve your patient’s transfer practices
Make moving your patients safer and smoother for everyone involved with these 5 tips:
1. Follow the safety rules
Your hospital needs to have internal policies that align with national safety standards. This way, your facility will be in line with the law while keeping patients safe.
2. Train your staff well
Place trust in your staff and teams, but they need to know how to properly handle a transfer. Implement regular training to help your staff feel confident about their skills and avoid errors and delays.
Training your staff properly and getting them on board can also help you prepare for the Joint Commission survey.
3. Talk to patients and their families
Keep family members and patients informed of any transfer. This way, patients feel less scared and anxious and are also more satisfied with their care.
4. Build a team to evaluate transfers
A problem-solving team could help you evaluate how transfers are working in your hospital, identify what needs to improve, and how to improve it.
5. Welcome feedback
After a transfer is completed, you can ask patients and family members how it went. You can keep improving based on any experiences they share with you.
Avoid these pitfalls when transferring patients
Many common errors can change patients' outcomes. Work to avoid these pitfalls:
- Incomplete handoffs: If staff omit key details, it could lead to health deterioration and readmissions.
- Transport instability: Patients must be stable to be transferred; otherwise, they risk decompensating.
- Documentation omissions: If you forget to do EMTALA forms, your facility risks facing audits.
- Communication errors: Ensure everyone involved agrees to the transfer and knows what to do, this includes the receiving facility.
- Ignoring psychosocial needs for patients: Patients might feel anxious or scared; this anxiety might lead to complications during or after the transfer.
A safe transfer results in better patient outcomes
It’s true! Patient care will always be complex, but your facility can greatly benefit from safe transfers. With safe transfers, you are more likely to see:
- Higher recovery rates
- Lower total costs
- Higher satisfaction scores
Your facility can see reduced mortality rates and improved HCAHPS scores when handling seamless handoffs.
Ready to optimize your operations to support quality scores, clinician retention, and more? Explore resources for facility administrators from Nursa.
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