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Our philosophy in our Pediatric ED, which is rigorously enforced by myself
and admin, "never say no".  I have worked in rural EDs and general ED's, as
the medical director for the regional tertiary Children's Hospital and
colleague for ED docs across the state,  refusing a transfer is never an
option unless for some extremely rare reason the child might suffer more by
the transfer.  A call for help or assistance from outside the tertiary
facility with all its resources and expertise is a responsibility that our
staff are taught to welcome and respect.

As I have n many issues over the years, I agree with Rachel

Matthew 

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Stanley, Rachel
Sent: Sunday, February 24, 2013 7:45 PM
To: [log in to unmask]
Subject: Re: Transfers to and from other Hospitals

I have to agree with Halim, we need to think long and hard before refusing
sick pediatric patients especially if we are the only show in town. 

This is obviously dependent upon what your local pediatric geography looks
like but some patients may be better served in your tertiary pediatric
hallway with the appropriate pediatric care and specialists than in the
nicest suite in an adult hospital. 



-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Halim Hennes
Sent: Saturday, February 23, 2013 7:54 PM
To: [log in to unmask]
Subject: Re: Transfers to and from other Hospitals

I think we all need to take a closer and more objective look at the issue
before we make such statements. If you are the only pediatric tertiary care
facility in the region and/or the only level one pediatric trauma center is
not an option that can better serve children in your region other than you
Over crowding and no beds is a common scenario. We need to be more creative
and partner with hospital administrators, inpatient and ICU colleagues to
develop a viable process that help you accommodate these transfer requests.
We were very successful accomplishing this in Dallas. Happy to speak with
anyone who is interested. Best regards


Halim Hennes
Sent from my iPhone

On Feb 23, 2013, at 6:14 PM, "Soglin, David" <[log in to unmask]>
wrote:

> I also agree.  The point of a transfer is to increase the level of care
the patient receives because the transferring hospital does not have the
facilities or skill set to provide an appropriate level of care.  The truth
of the matter is that when you are full, you also don't have the facilities
to provide optimal care for the patient.  All of our formal transfer
agreements specifically state that we will accept their transfers when we
can and having no beds is a reason to turn them down.  If it is a hospital
at we work with closely and often, we will assist them in finding another
institution for the patient.  
> 
> David F. Soglin, M.D.
> Chair, Department of Pediatrics
> Cook County Health and Hospitals System Stroger Hospital of Cook 
> County (Cook County Hospital)
> 
> 
> 
> On Feb 23, 2013, at 15:12, "Mike Falk" <[log in to unmask]> wrote:
> 
>> Strongly agree with James on this: full is full!  How can you reasonably
care for a sick patient when you can't actually provide a space for them?
Even then, overcrowding becomes dangerous and we do it during disasters and
times of crisis because we have NO other option.
>> Mike Falk
>> 
>> Sent from my iPhone
>> 
>> On Feb 23, 2013, at 2:52 PM, james reingold <[log in to unmask]>
wrote:
>> 
>>> If you have no capacity (beds) to care for the patient you are under 
>>> no obligation to accept and probably shouldn't unless there are 
>>> major extenuating circumstances
>>> 
>>> James
>>> 
>>> Sent from my iPhone
>>> 
>>> On Feb 23, 2013, at 12:34 PM, "Julia Whitefield"
<[log in to unmask]> wrote:
>>> 
>>>> Dear Colleagues:
>>>> In your hospitals, how has your administration or you as these
administrators of your departments/divisions handled accepting transfers
when your hospitals are full? And here I mean NO beds on the regular
pediatric floors (incl. subspecialty floors), NO room in observation units,
NO rooms in PICU and NO rooms in your EDs where you end up putting patients
into the hallway, which is now full also.
>>>> 
>>>> Do you accept them all anyway or if you have declined transfer? And if
you have declined transfer, how has your administration handled this for the
future?
>>>> 
>>>> I would so welcome your feedback and would appreciate your answers
directly to my e-mail address.
>>>> Thank you -
>>>> 
>>>> Julia
>>>> Julia Whitefield MD, Ph.D.
>>>> Albuquerque
>>>> 
>>>> 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:
>>>>              http://listserv.brown.edu/ped-em-l.html
>>> 
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>> 
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>> the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
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>> 
> 
> For more information, send mail to [log in to unmask] with 
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>                 http://listserv.brown.edu/ped-em-l.html

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