General Transfer Guidelines

General Transfer Request Guidelines Transfer requests from non-medicine teams: The consult attendings have historically used “the 48-72 hr rule.” Specifically, this means, if the issue for which the non-medicine team is requesting transfer is something the medicine team can possibly address by consult within 48 to 72 hours, we recommend a medicine consult rather than transfer. If a team requests to transfer a patient being followed by the Medicine Consult attending, discuss appropriateness of transfer with provider on service. We do not accept transfers to Medicine simply because a patient has “no further surgical needs” unless there are active medical issues that need to be addressed. We do not accept patients to Medicine to assist with disposition. If a non-medicine team specifically requests transfer to a non-HM team that is affiliated with the patient in some fashion (for example, as a consultant in the hospital or as patient’s outpatient subspecialty provider; think Geriatrics, Oncology, Renal Transplant, etc), they should reach out directly to the team they are wanting to transfer the patient. If we are moving towards opening Morgan side services (i.e. moving to surge plan purple), it is reasonable to have the MACs move to requiring a call from an attending to the AOD to discuss any transfer requests. Transfer requests from medicine subspecialty teams: These should be rare, but they may occur if a subspecialty team has an urgent/emergent need to bring somebody to their service for their expertise when they are capped. For these requests, the subspecialty attending should call the AOD. Transfer requests from Morgan teams: These should be exceedingly rare and require an attending to AOD phone call to understand what is unique about this situation that requires such a transfer. Transfers out of the MICU: When we are operating in green/yellow/orange, we generally can take patients out of the MICU as they call them to the MAC. At red capacity and above, our agreement with the MICU is we will go into the evening with at least 10 boarders (if they have identified that many) so they have people to easily move to an open bed when needed. As we get very busy (purple and above), it sometimes becomes necessary to slow the transfers out of the MICU. The wording to the MICU at these times is that we will accept transfers as we identify discharges. Please use this wording rather than phrases like cannot accept transfers.

Transfers out of the other ICUs: These are generally reviewed just as other off-serve transfer requests. However, sometimes these requests are sent to Medicine because 1) the patient started on a Medicine team, moved to the MICU and laterally transferred to another ICU when an emergent need arose for and MICU bed, 2) the patient was on a Medicine team and ended up in a non-MICU intensive care unit due to bed availability, or 3) a patient who would usually go to the MICU was directly admitted through the ED or from an OSH to a non-MICU intensive care unit due to bed availability. The other ICUs have graciously agreed to take these patients with an ICU attending as primary rather than a Medicine team. These patients MUST come back to a medicine team. It is reasonable to slow the transfer for a discharge to be identified if needed; however, please be sure to emphasize we are taking the patient as soon as possible.