Transfer and Stabilization for Certified Emergency Nursing (CEN)

Transfer and Stabilization

Definition/Etiology:

EMTALA (Emergency Medical Treatment and Active Labor Act) requires hospitals that participate in Medicare to:

• Provide all patients with a medical screening examination, regardless of ability to pay, having insurance, or being eligible for Medicare/Medicaid. 
• Stabilize any patients with an emergency medical condition, including an unborn child. 
• Transfer or accept appropriate patients as needed.

Pathophysiology:

13% of women of child-bearing age do not live within 50 miles of a hospital with L&D and a NICU.

If the transferring hospital is unable to stabilize the patient due to lack of needed services (neurosurgery, etc), then this should be well-documented by the provider. 

Contraindications:

• Lack of appropriate modality for transfer (critical care paramedics if needed, etc)
• Unsafe weather/road conditions
• Maternal condition insufficiently stabilized (persistent hemorrhage, refractory hypertension)
• Delivery is likely before transport is complete
• Unstable fetal condition threatening to deteriorate rapidly (delay in delivery would result in death or damage to the fetus)
• Patient declines transfer

Clinical Presentation:

Many different presentations are possible:  

• Any patient that requires services that are not available at your facility (cath lab, L&D, NICU, interventional radiology, neurosurgery, etc)
• If your facility is full, and no beds available
• Occasionally by patient request

RN may be required to travel with the patient if blood is transfusing, etc.

Collaborative Management:

Records that should accompany patient:

• Medical record thus far
• Informed consent
• EMTALA transfer form with name of accepting physician

Evaluation | Patient Monitoring | Education:

• Continuous cardiac, NIBP, and SaO2 monitoring
• Two peripheral IVs if possible
• Clear communication and handoff to transport team and to receiving facility: MD to MD and RN to RN.

Linchpins: (Key Points)

• EMTALA transfer form, medical record thus far
• Informed consent
• Utilize charge RN
• Clear communication with transport team and receiving facility