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 5: / Line 5: @@
 ** '''DHS Empaneled or DHS Eligible only'''
 *** If OOP, goal is to transfer to in-plan hospital
-*** Only OOP Exception - Kaiser:  '''during Kaiser strike ONLY''', place IQ request; once given authorization to admit after doc-to-doc conversation, place the "Consult to Transfer Center" order
@@ Line 20: / Line 19: @@
 ***** Provider name/Call Back Number
 ***** Is the patient receiving chemotherapy (should be "no")
-**** MAC/RLA PAC does their own financial clearance process and 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 (doctor on duty daytime/hospitalist on duty after-hours) 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
@@ Line 27: / Line 31: @@
 ***** 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)