Harbor:ED to Rancho Los Amigos (RLA)

• 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