Harbor:ED to Infusion Center

• Draft - not is process yet!
• Blood, Iron, IV fluids
• 1st (by RN office) & 5th floor (5E) infusion centers
  • 8a - 4p; DHS/eligible only

Path resident consents for blood transfusions Triage resident for calls

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Patient Eligibility Criteria (ED Provider)

Eligible patients must meet all the following criteria prior to transition from the Emergency Department (ED) to the Infusion Center: • Hemodynamically stable with no indication for continued ED monitoring or inpatient admission • Appropriate for outpatient Infusion Center services, including: • Blood transfusion • Iron infusion • IV hydration • No active bleeding, high risk for severe transfusion/infusion reaction, or unstable comorbid conditions requiring a higher level of care ED Provider Responsibilities

• Submit an Infusion Center referral through the HAR-OP-INFUSION message pool • Clearly specify the following in the referral: - Clinical indication (e.g., anemia, dehydration) - Type of infusion/service requested (e.g., PRBC transfusion, iron infusion, IV hydration) - Ordered dose, infusion rate, and any special instructions or precautions • Ensure all required laboratory studies are completed prior to referral, including: - CBC - Type and crossmatch (for transfusion requests) - Iron studies, if applicable Nursing Coordination Responsibilities (ED Nurse)

• Confirm patient stability and appropriateness for discharge prior to transition to the Infusion Center • Ensure appropriate IV access is established when indicated per protocol • Provide patient education regarding: - Infusion Center appointment details - Expectations during the infusion visit - Return precautions and indications for seeking emergent care • Communicate directly with the Infusion Center nurse to provide clinical handoff and ensure continuity of care Infusion Center Scheduling & Coordination

• Verify referral and orders • Schedule a same-day or next-day appointment • For Blood Transfusion, check with BB if blood product is available • Confirm staffing and chair availability 5. Patient Transition

• Patient discharged from ED with: o Appointment time and location (if same day) o If after hours, inform the patient to expect a call from the Infusion Center to schedule the patient's infusion or blood transfusion appointment. o Instructions and contact information • Transport: o Ambulatory / family transport (no medical transport required unless indicated) (if the same day) Infusion Center Responsibilities

• Check in the patient and complete the intake assessment, including vital signs, medical history, and review of ED documentation • Verify provider orders, required laboratory results, and transfusion consent documentation (Pathology will obtain and provide transfusion consent) • Administer infusion therapy, including blood products, iron infusions, and IV hydration, in accordance with established protocols and safety standards • Monitor and observe patients for adverse reactions during and after infusion therapy • Initiate emergency response protocols immediately if an infusion or transfusion reaction occurs • Promptly escalate and communicate with the ED and/or ordering provider if the patient develops any adverse reaction or change in clinical condition during treatment Documentation

• Emergency Department (ED): Document referral details, confirmation of clinical stability, and discharge instructions provided to the patient • Infusion Center: Document treatment rendered, patient tolerance and response to therapy, and any adverse events or complications encountered during care Safety Considerations

• Strict adherence to established patient eligibility and exclusion criteria • Maintenance of emergency response protocols for infusion and transfusion reactions • Clear escalation and transfer pathway back to the Emergency Department (ED) for any patient demonstrating clinical instability or adverse changes in condition CONTACT INFORMATION:

Infusion Center: x65591 ED Provider: ??? Triage Army Charge Nurse: x66950