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Important caveat to remember about the Federal EMTALA laws which guide interfacility transfers... Interpretation of "full" is not always so clear.  If a facility has demonstrated (in the past) the ability to "flex up" and go "beyond full," then that may be the new standard to which the facility may be held.  For example, if you have gone above "full" in extenuating circumstances to admit over-flow patients to your PACU, it is possible that you would be held to that "new full" expectation.
Good discussion!
Nick.

Nicholas Tsarouhas, M.D.
Medical Director, Emergency Transport Team
Associate Medical Director, Emergency Department
The Children's Hospital of Philadelphia



-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Soglin, David
Sent: Saturday, February 23, 2013 7:15 PM
To: [log in to unmask]
Subject: Re: Transfers to and from other Hospitals

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 
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>> 
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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:
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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:
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