Harbor:ED to Infusion Center

• Draft - not is process yet!

• Who? DHS/eligible only
• What? Blood, Iron, IV fluids
• When? Mon - Fri, 8a - 4p
• Where? 1st floor (by RN office) & 5th floor (5E) infusion centers
• Contacts:
  • Infusion Center x65591
  • Triage Resident x66923; RME Charge RN x66950
  • Pathology resident consents for blood transfusions at the infusion center

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

Patient Transition

• Patient discharged from ED with:
  • Appointment time and location (if same day)
  • If after hours, inform the patient to expect a call from the Infusion Center to schedule the patient's infusion or blood transfusion appointment.
  • Instructions and contact information
• Transport:
  • 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