Hailey Tran
Transferring hospitals can be a stressful process, but it may be necessary to ensure a patient receives the best care. Patients may need to be transferred to another hospital when the current hospital cannot provide the care they need, or the patient or their family is dissatisfied with the quality of care. In some cases, patients may be refused a transfer if the hospital determines that it will not impact their outcome or if the risks of moving them could worsen their condition. To initiate a transfer, patients or their loved ones should reach out to their hospital case manager or social worker, who can help advocate for their needs. It is important to remember that there is no guarantee that the preferred hospital will accept the transfer, and the process may be challenging.
| Characteristics | Values |
|---|---|
| Reasons for transfer | The hospital can't provide the care the patient needs |
| The patient or their family is dissatisfied with the quality of care being delivered | |
| To upgrade or downgrade the complexity of care | |
| The hospital isn't equipped to handle a specific situation | |
| The patient requests a transfer to a hospital closer to their loved ones | |
| Transfer process | The patient or their loved ones initiate the transfer process by asking their providers whether a transfer is necessary |
| The provider must order the transfer request | |
| The hospitals sort out the transfer and how it will proceed | |
| The patient needs to find an accepting physician at the new hospital | |
| Transfer challenges | The hospital may refuse a transfer if it believes the change won't impact the patient's outcome or if the risks of moving worsen their condition |
| There is no central authority to support the transfer process | |
| The desired hospital may not have the capacity or willingness to accept the patient | |
| Transferring to a different hospital may be costly |
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What You'll Learn
Transfers for specialised care
In some cases, a patient may need to be transferred to a hospital with specialised units, such as a neonatal unit for high-risk deliveries. Similarly, a patient recovering from heart surgery may no longer require the 24-hour support of the ICU and can be moved to a basic cardiac unit.
Before initiating a transfer, it is important to ensure that the desired hospital has the capacity and capability to provide the necessary care and that it is ready to take on the patient's needs. This involves finding an accepting physician at the new hospital to ensure a safe transition.
To begin the transfer process, patients or their loved ones should express their concerns and ask their current care team about the possibility of a transfer. While patients have the right to request a transfer, the current treating hospital is not obligated to agree to it, especially if the change is not deemed medically necessary or if transferring the patient could worsen their condition.
It is recommended to involve a hospital case manager or social worker who can advocate for the patient's needs and help navigate the complexities of the healthcare system. Additionally, seeking a second opinion from another doctor within the same hospital or through a telehealth consultation with a doctor at another hospital can be a beneficial first step before pursuing a transfer.
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Navigating the transfer process
Understanding the Reasons for Transfer
Firstly, it is important to understand the reasons behind the transfer request. Transfers typically occur when the current hospital cannot provide the required level of care or when the patient or their family is dissatisfied with the quality of care. In some cases, transfers may be preventative, anticipating future complications that the current hospital may not be equipped to handle. For instance, a patient experiencing kidney failure at a rehabilitation facility may need to be transferred to a hospital with dialysis facilities.
Initiating the Transfer Process
To initiate a transfer, it is recommended to speak openly with your care team about your concerns and ask whether a transfer is necessary and beneficial. This conversation can improve communication and ensure everyone is on the same page regarding the treatment plan. Remember, it is ultimately the hospital's decision to approve the transfer request.
Finding an Accepting Physician
Before a transfer can take place, an accepting physician at the new hospital is required. The receiving physician will coordinate with the current physician to arrange the transfer and ensure they can meet your needs. It is important to select a hospital that can offer better care than your current one.
Understanding Transfer Guidelines and Rights
It is important to understand your rights as a patient regarding transfer requests. The Centers for Medicare and Medicaid Services (CMS) has established patient transfer guidelines that Medicare-certified hospitals must follow. Additionally, CMS mandates that patient-requested transfers should be granted as long as the desired hospital can provide the necessary care.
Considering Costs and Logistics
Transferring to another hospital may involve additional costs, such as ambulance fees, mileage costs, and waiting-time fees. It is essential to consider these financial implications when planning a transfer. Additionally, there is no guarantee that your preferred hospital will have an available bed or be willing to accept the transfer.
Navigating a hospital transfer can be a complex process, but by following these steps and advocating for your needs, you can increase the chances of a successful transfer to a more suitable healthcare facility.
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Patient and family rights
Patients and their families have certain rights when it comes to hospital transfers. While navigating a hospital transfer can be challenging, patients and their families can play an active role in initiating the transfer process and advocating for their preferred course of action. Here are some key rights and considerations for patients and their families:
- Right to Transfer: Patients have the right to transfer to another hospital. This right is affirmed by experts such as Arthur Caplan, a professor of bioethics and director of the division of medical ethics at New York University Langone Medical Center. However, it's important to note that the responsibility for finding a hospital that agrees to accept the patient falls on the patient and their family.
- Quality of Care: Quality of care should be the top priority when considering a hospital transfer. Patients and their families have the right to assess whether the current care team's approach is effective and aligned with their needs. Indicators such as hospital-acquired infection rates, timelines of care, and rehospitalization rates can be discussed with the care team to determine if a transfer is warranted.
- Communication Breakdown: Often, transfer requests arise from a breakdown in communication between the patient, their family, and the healthcare providers. In such cases, patients and their families have the right to request a social worker or patient relations professional to act as an intermediary. Open communication can help resolve issues and ensure everyone is on the same page regarding the treatment plan.
- Patient Advocacy: Hospital case managers, social workers, and patient advocates are committed to advocating for patients' rights and needs. Patients and their families can reach out to these professionals to initiate transfer discussions and navigate the complexities of the healthcare system. These individuals can provide valuable support and guidance throughout the transfer process.
- Right to Question Refusal: If a hospital refuses a transfer request, patients and their families have the right to question this decision. They can request a meeting with the hospital's ethics committee, which all hospitals are required to have. If the ethics committee is not successful, approaching the chief medical officer or a patient advocate may be the next steps. These individuals have the authority to overturn decisions and work towards resolving issues.
It's important to remember that while patients have the right to transfer, the final decision to accept the transfer rests with the receiving hospital, considering factors such as capacity and capability to provide necessary care. Additionally, transfers should be carefully managed to prevent negative consequences associated with fragmented care.
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Transfer delays and setbacks
Another factor contributing to transfer delays is the lack of standardised information sharing between hospitals. Sending hospitals may not provide comprehensive information about the patient, leading to variability in transfer requests. This can result in repeat imaging and delayed care, as receiving physicians may not fully understand the patient's needs until they arrive.
Additionally, insurance-related issues can cause transfer delays. Patients and their families may need to complete necessary insurance forms, which can take hours and place patients at increased risk for health complications. Furthermore, hospitals are not prohibited from turning down inpatient transfers due to a patient's insurance coverage, which has been a problem during the COVID-19 pandemic when some hospitals refused to accept patients based on their insurance status.
Transfer delays can have serious consequences, including an increased risk of health complications and even death. They can also lead to dissatisfaction among patients, family members, and clinicians. It is crucial for hospitals to address these delays and streamline their transfer processes to ensure patient safety and provide efficient care.
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Finding a better fit
When considering a transfer, the first step is to decide where you would like to transfer. You will need to find an accepting physician at your desired hospital to ensure it is the right place for your care needs. Think about the quality of care and whether the hospital you are considering transferring to can offer better care than what you are already receiving. Quality of care should be every patient's first priority.
You can reach out to your hospital case manager or social worker to initiate the transfer process, as these professionals are experts in the healthcare system and will advocate for you and your needs. It is important to explain your concerns calmly and plainly. Asking about a transfer can also spur your current provider to step up their communication and may resolve any issues. More than 90% of the time, this can improve the engagement of the provider team.
It is important to note that transfers related to concerns about the quality of care are often about a breakdown in communication between the provider and the patient. Transfers can be made to upgrade or downgrade the complexity of care. For example, a patient recovering after heart surgery may no longer require the 24-hour support of the ICU and may move to a basic cardiac unit for the final days of recovery.
There are three main types of patient transfers: primary, inter-hospital, and intra-hospital transfers. The goal of most primary and intra-hospital transfers is to get the patient to a facility that can provide the level of care they need as quickly as possible. For example, if a patient experiences kidney failure while at a rehabilitation facility, they would need to be transferred to a hospital with the equipment and staff necessary to administer dialysis.
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Frequently asked questions
There are two broad reasons for transferring hospitals: The hospital can’t provide the care the patient needs, or the patient or their family is dissatisfied with the quality of care being delivered. Transfers can also be made to upgrade or downgrade the complexity of care.
First, determine where you’d like to transfer. Then, reach out to your hospital case manager or social worker to initiate the transfer. You will need to find an accepting physician at the new hospital. The current hospital's provider will then need to order the transfer request.
Transfers related to concerns about the quality of care are often about a breakdown in communication between the provider and patient. There is also no guarantee that the preferred hospital will have an available bed or be willing to take on the patient. Transferring hospitals can be difficult, and patients may be refused a transfer if the hospital determines that the change wouldn’t impact the patient’s outcome or if the risks of moving the patient could worsen their condition.
