Clear communication with fellow health care workers is a vital part of long-term care. Our Emergency Room Physician (ERP) colleagues have recommended that LTC Physicians and NPs be more involved in ED transfers by providing details about a residents’ goals of care, expected status, events leading to ED transfer, and criteria for return to the care home. See below for ED transfer processes and examples.

After-Hours ED Transfers

For communication between nursing staff and physicians, please see this one-pager outlining the steps for initiating and communicating a transfer to the Emergency Department, including ED phone and fax numbers.

Transfers To ED Process: MRP & Nurse Communication

I. Discuss with the Nurse the reason for transfer:

  • What (or why) the resident is being transferred for and your requests of the ED team (ask yourself, “what am I asking to be done for my patient?”)
  • When the resident can safely return/what needs to be achieved before they can return (“please return the patient to our care home when_______________”)

II. Ask the LTC Nurse to write the what and when in the “Reason for Transfer” section of the ED Transfer Form.

III. Inform the ERP regarding the clinical course resulting in the need for ED treatment. Either:

  • Call the ED directly to give a verbal report to the ERP, or
  • Fax a progress note directly to the ED, or
  • Write a progress note into Powerchart (title note “ED Patient Transfer”)

What To Communicate: Examples

Unsure of what information to share? Relay what relevant symptoms can be managed at the care home.
Brainstorm these points with the Nurse. Your input helps ED physicians determine when it is appropriate to discharge a LTC patient and when they need to be admitted to inpatient care.

  • Examples of care not available at most LTC homes: IV fluids, IV antibiotics, administrations of blood or blood products, RT (except for Aberdeen Hospital).
  • Delayed: Oxygen, specialized equipment (time to set up), daily PT or OT.

Abdominal Pain Example
87-year-old patient has had worsening abdominal pain for 3 days and now soft signs of peritonitis. Please investigate causes of stomach pain and return her to care home as soon as treated in accordance with family wishes (please review goals of care in context of this new diagnosis). Pain or other non-acute causes can be managed at [name of LTC home], or any palliative symptoms.

Increasing Aggressive Behaviour Example
72-year-old man recently admitted to LTC home. Diagnosis included mixed dementia with behavioural and psychiatric symptoms. Numerous behaviour incidents since admission, culminating in a serious incident of physical aggression and harm to co-resident and staff member this afternoon. Code White and IM injection unsuccessful in de-escalating, continues to pose high risk for further incidents causing harm to others. Requires a more secure environment, behaviour stabilization, geriatric psychiatry assessment, and possible readmission to 2 South. Cannot return to LTC home without the agreement of care home management.

**If transfer is because of aggressive behaviour causing harm or risk of harm to co-residents or staff, the care home manager/DOC needs to be consulted before a return plan can be made.**

Fall With Injury Example
Patient fell and can no longer bear weight. Please x-ray left ankle and treat if fractured. Otherwise, return patient to care home promptly.

Hospital Transfer Requested by Family
77-year-old frail woman with end-stage lung disease has fever, increased RR, low LOC and low O2 (normal is low 90s). Family insists on hospital assessment. Please return her to care home as soon as possible. LTC home can provide up to 5L of O2, oral antibiotics, and symptom control.

Please contact the LTCI team (778-265-3137) if you need ED phone or fax numbers for VGH, RJH, or SPH.

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