Harbor:ED to Rancho Los Amigos (RLA)

• ED to RLA (2/10/2026) for patients 18 y/o and older
  • Stable vs Unstable
    • If unstable for transfer, admit!
    • For now, no ICU admissions from ED to RLA (HUMC ICU can consider lateral transfers)
  • DHS Empaneled or DHS Eligible only
    • Only OOP Exception: during Kaiser strike, place IQ request; once given authorization to admit after doc-to-doc conversation, ok to place the "Consult to Transfer Center" order
      • If OOP, goal is to transfer to in-plan hospital
      • If "DHS Empaneled" or approved for admission, proceed to next step
  • To initiate transfer
    • Place Orchid order for "Consult to Transfer Center"
      • Enter the following info:
        • Requested level of Care
        • HUMC attending
        • Reason for transfer: "Acute medicine (Rancho Los Amigos)"
        • Patient Consented for Transfer (yes/no) - I would verbally consent, then do written EMTALA if patient accepted
        • Provider name/Call Back Number
        • Is the patient receiving chemotherapy (should be "no")
      • MAC does their own financial clearance process and will inform us if there is no capacity for this level of care at RLA
      • RLA MOD/HOD (doctor on duty daytime/hospitalist on duty after-hours) will call back within 15 minutes for doc-to-doc/review and exclusion criteria
      • If the patient is accepted:
        • Need signed EMTALA
        • ED clerk will schedule BLS or ALS transport via Round Trip
        • HUMC RN will call RLA RN
      • If the patient is declined by the RLA MOD, contact UR for admission clearance at HUMC if not already MET
  • General Exclusions for RLA
    • Acute Gastroenterology/Hepatology services need (acute GI bleeds)
    • Any cardiac issues deemed by cardiology team as likely needing invasive procedures such as Cath, CTS, or electrophysiology consult
    • Neurosurgical needs
    • Acute general surgery or ortho surgery needs (they have full podiatry services for DFI, etc.)
    • Acute Vascular surgery needs
    • Likely Oncology or urgent hematology needs
    • Patients being admitted solely for placements (can be placed if primarily admitted for medical need)