Transfer of Care

[1aCe3]

When exactly is the care officially transfered over to the recieving department?

Example that had me wondering : A stable Psych transport from ER to recieving Psych facility infamous for it's long admissions process had us waiting for 1hr + at the facility. Our PCR was not signed, but admissions knew we were waiting, and the did a short prescreening interview with the pt and continued to do the paperwork. After this process we would usually drop the pt off to the designated floor. The potentially suicidal pt with numerous mental problems wanted to go to the bathroom. I asked the nurse if it was ok - she said yes, and the pt followed to lock himself in the 1 person bathroom to do his business. Now nothing bad had happend in these numerous times, but what if the pt had locked himself in there and followed to hurt himself. Would we be held liable since care had not been officially transfered? I usually will tell the pt to wait until we were able to transfer him upstairs, but some of them can get a lil riled up.

EDIT : Just an additional note, this situation(s) occurs on the admissions floor with offices, there are no beds/medical equipment - ie. Urinals.

[n5iln]

Ouch. That's a touchy one. IMO, though, once you've given your verbal report and they've started their admissions process (including interviewing the pt), they've accepted responsibility for that pt. The problem is in how to document that transfer of care.

Our documentation standards call for an entry in the "disposition" section of the PCR, something like this: "Gave report to RN Smith and moved pt by two-person drawsheet lift onto gurney in ER Room 6." We have to say where we left the pt, how we got him off our stretcher, and who from the receiving facility was there to take our report. Once we've accomplished that, as the Lone Ranger would say, our work here is done.

The difficulty lies in whether a lawyer wants to view what's on the front of the PCR as any more or less important than a signature from an admissions clerk, RN or whatever. If your documentation supersedes the missing signature, you're in the clear. If not, you've committed abandonment.

My short answer (too late, I know) is to check with your supervisor. If they don't know, hound them until they talk either to corporate office or to the local attorney who handles your service's legal affairs. But if this is a common occurrence in your service, I'd say it's fairly important to find out exactly when the transfer of care takes place.

[canuckEMT]

Our transfer is complete once report is given to the recieving RN and Pt is transfered to their bed. If there is an initial consult, and the RN did not tell you what bed to put him/her in then you are still responsible for that Pt.

If it was a suicidal Pshyc Pt then I would have wheeled behind a curtain and gave a urinal.

Technially you would still be responsible for that Pt as our protocols state. Then again check with your supervisor and/or Medical Director and protocols.

[Ridryder 911]

Once the accepting nurse has taken report and made contact with that patient. Since he/she did not make physical contact, I would feel if something happened it would be a shared responsibility. I agree as a health care provider, you allowed a "potential suicidal" patient to isolate themselves. Likely, they will describe that they had not intervened with the patient yet. Both sides would be responsible. You as a provide know better...

R/R 911

[Nate]

Once the accepting nurse has taken report and made contact with that patient. Since he/she did not make physical contact, I would feel if something happened it would be a shared responsibility. I agree as a health care provider, you allowed a "potential suicidal" patient to isolate themselves. Likely, they will describe that they had not intervened with the patient yet. Both sides would be responsible. You as a provide know better...

R/R 911

I agree with the above statement. Generally with a pysch patient, we have not "released care" until the nurse sings off on our run report and is physically with the patient. Granted in Texas they are considered the hospital's problem the minute you walk through the door, the jury won't see it that way if something was to happen to the patient (and you can bet the hospital is going to push this off on you).

[1aCe3]

conclusion... let em wait... or pee with you standing by a open door. +Check with company protocol.