On occasion, we do accept. The EMTALA usual rule of thumb is that a patient may not be transferred to a lower level of care (For this purpose, the ED is considered a lower level of care than an inpatient bed). However, it can be argued that a Pediatric ED may provide a higher level of care than an inpatient unit at a non-pediatric facility.
If you truly have no inpatient beds available, it is not technically an EMTALA violation to accept the patient. Although you have to have capability AND capacity, if you are able to care for the patient safely in the ED, then you have the capacity.
The big rub in all of this is patient satisfaction. Patient leaves a hospital's inpatient unit where they may have a private room and bed, are transferred via ambulance, and are placed on a stretcher in an Emergency Department for what may be hours, with the understanding that the reason for transfer is that you're going to fix everything that the other hospital didn't accomplish.
Finally, if the hospitalist accepts the transfer, and you haven't established a mechanism whereby the hospitalist is communicating with the ED, then the hospitalist is technically responsible for that patient. Hopefully, improved communication will avoid this issue.
Niel Miele, M.D.
New Brunswick, NJ
> Date: Mon, 2 Feb 2015 15:01:36 -0500
> From: [log in to unmask]
> Subject: Inpatient transfers
> To: [log in to unmask]
> Does your ED accept transfers of INPATIENTS from other hospitals? If so, is the PEM attending a part of the decision to accept the patient or does the hospitalist accept them without PEM attending involvement?
> Do you take inpatients from other hospitals when there are no floor or PICU beds available in your hospital? Does it depend on whether there are already admitted patients boarding in the ED and whether the ED volume is high?
> If the hospitalist accepts them without PEM attending involvement, shouldn't either the transferring MD or the hospitalist inform the PED of the transfer?
> Thanks for your input.
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: