State of Maine

Maine Board of Licensure in Medicine


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Medical Board Rules

3. STANDARD: TRANSFER OF PATIENT TO OTHER HOSPITALS.

A. The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) as amended sets forth federal guidelines and provides civil penalties for noncompliance in the matter of improper transfer of patients between hospitals.

B. The COBRA defines "Emergency Medical Condition" and "Stabilized Condition" as follows:

(1) Emergency Medical Condition: A condition which manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

(a) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; or,

(b) serious impairment to bodily functions, or

(c) serious dysfunction of any bodily organ or part,

(d) there is inadequate time to effect a safe transfer to another hospital before delivery, or

(e) a threat to the health or safety of the woman or the unborn child if transfer is initiated while a patient is in active labor (i.e., patient is having contractions).

(2) Stabilized Condition: A patient's condition has been stabilized if no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility. A patient in active labor has been stabilized if she has delivered (including the placenta).

C. Figure 1, "CHECK LIST FOR TRANSFER OF PATIENTS TO OTHER HOSPITALS" is the model adopted for use in Maine Hospital Emergency Departments of a form which should be used to insure compliance with COBRA in effecting interhospital transfer of patients. This format may be reproduced locally or modified to incorporate administrative or demographic data required by individual facilities.

Figure 1. CHECK LIST FOR TRANSFER OF PATIENTS TO OTHER HOSPITALS

SENDING HOSPITAL:________________________________________

NAME: ______________________ DATE:_______________________

RECEIVING HOSPITAL:______________________________________

RECEIVING PHYSICIAN:_____________________________________

RECEIVING HOSPITAL ADMIN REPRESENTATIVE:_______________

Y No 1. Patient stabilized. (if unstable reason documented on chart.)
Y NA 2. Reasons for and the risks/benefits of transfer explained to the patient/family and documented on chart.
Y No 3. Patient/guardian signed Transfer Consent forms.
Y NA a. Patient unable to sign.
Y NA b. No guardian present.
Y NA 4. Contact made with the accepting physician, case reviewed, the physician accepts the patient.
Y NA 5. Receiving institution administrative representative accepts patient.
Y NA 6. Notified the receiving nurse of the patient's condition and transport arrangements.
Y NA 7. Arranged appropriate transportation.
Y NA 8. The necessary trained personnel will accompany the patient with appropriate equipment, including:

Y NA a. medical personnel qualified to handle the existing condition and anticipated problems.
Y NA b. appropriate IV access.
Y NA c. appropriate airway management.
Y NA d. appropriate medications.
Y NA e. orders regarding monitoring Vital Signs and Medical Control.
Y NA 9. The patient's stability was reassessed immediately prior to transfer. Unstable patients should only be transferred when the hospital lacks the capability to stabilize the patient.
Y NA 10. All appropriate, if available, medical records, including the completed Emergency Department chart, X-Ray, Lab, and EKG reports are to accompany the patient or be faxed to the facility.
Y NA 11. Care of the patient should be formally accepted by appropriate medical personnel at the receiving facility.

PHYSICIAN'S SIGNATURE:

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