Harbor:ED to Rancho Los Amigos (RLA): Difference between revisions

Latest revision as of 22:46, 11 March 2026

ED to RLA (2/10/2026)
- Stable vs Unstable
  - If unstable for transfer, admit!
  - No ICU admissions from ED to RLA (HUMC ICU can consider lateral transfers)
- DHS Empaneled or DHS Eligible only
  - If OOP, goal is to transfer to in-plan hospital

- ED to RLA Admission Process
  - Patients 18 y/o and older
  - MONDAY - FRIDAY, 8am to 10pm (must place the "Consult to Transfer Center" during these times)
- 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 UM RN will initiate Teams chat to acknowledge transfer request (3/11/26)
      - MAC UM RN
        Does financial clearance process
        
        Will inform HUMC doc if there is no capacity for this level of care at RLA
        
        Once financially cleared
        8a - 4p: case reviewed by RLA ACMO then assigned to RLA care team and bed assigned; at that point, doc-to-doc will occur
        
        4p - 10p: case reviewed by RLA ACMO then hospitalist will call HUMC for doc-to-doc
    - If the patient is accepted:
      - Need signed EMTALA
      - ED clerk will schedule BLS or ALS transport via Round Trip
      - MAC will connect HUMC RN with RLA RN once bed is assigned
    - 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)

Bradley Chappell, VC Clin Ops HUMC; Barry Jordan, CMO RLA; Michael Bolaris, ACMO RLA; Michael Scott, ACMO RLA; Peter Balingit, Medical Director MAC

Authors:

Bradley Chappell

@@ Line 1: / Line 1: @@
-* ED to RLA (2/4/2026) for patients 18 y/o and older
+* ED to RLA (2/10/2026)
 ** Stable vs Unstable
 *** If unstable for transfer, admit!
-*** For now, no ICU admissions from ED to RLA (HUMC ICU can consider lateral transfers)
+*** No ICU admissions from ED to RLA (HUMC ICU can consider lateral transfers)
-** DHS vs OOP
+** '''DHS Empaneled or DHS Eligible only'''
-*** If OOP, transfer to in-plan hospital
+*** If OOP, goal is to transfer to in-plan hospital
-**** '''UR needed for approval prior to transfer center, or transfer center doing the financial screening?????'''
-*** If DHS or approved for admission, proceed to next step
+** <big><big>ED to RLA Admission Process</big></big>
+*** Patients 18 y/o and older
+***'''MONDAY - FRIDAY, 8am to 10pm (must place the "Consult to Transfer Center" during these times)'''
 ** '''To initiate transfer'''
 *** Place Orchid order for "Consult to Transfer Center"
@@ Line 16: / Line 19: @@
 ***** Provider name/Call Back Number
 ***** Is the patient receiving chemotherapy (should be "no")
-**** MAC will inform us if there is no capacity for this level of care at RLA
+**** '''MAC UM RN will initiate Teams chat to acknowledge transfer request''' (3/11/26)
-**** RLA MOD/HOD will call back within 15 minutes for doc-to-doc/review and exclusion criteria
+***** MAC UM RN
+****** Does financial clearance process
+****** Will inform HUMC doc if there is no capacity for this level of care at RLA
+****** Once financially cleared
+******* 8a - 4p:  case reviewed by RLA ACMO then assigned to RLA care team and bed assigned;  at that point, doc-to-doc will occur
+******* 4p - 10p:  case reviewed by RLA ACMO then hospitalist will call HUMC for doc-to-doc
 **** If the patient is accepted:
 ***** Need signed EMTALA
-***** ED clerk will schedule BLS transport via Round Trip
+***** ED clerk will schedule BLS or ALS transport via Round Trip
-***** MAC will arrange for ALS transport
+***** MAC will connect HUMC RN with RLA RN once bed is assigned
-***** 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
+** '''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
@@ Line 31: / Line 41: @@
 *** Likely Oncology or urgent hematology needs
 *** Patients being admitted solely for placements (can be placed if primarily admitted for medical need)
+Bradley Chappell, VC Clin Ops HUMC;  Barry Jordan, CMO RLA; Michael Bolaris, ACMO RLA; Michael Scott, ACMO RLA; Peter Balingit, Medical Director MAC