Transfer Policy to an Internal Medicine Inpatient Service

Objective:  The policy is an acknowledgement that any internist, whether a generalist or subspecialist, is able to determine when a patient needs inpatient care primarily directed by an internist. When an internist makes that determination, he/she should be able to coordinate a smooth transfer to an internal medicine service. Transfers, unless emergent, should only take place between the hours of 8am-5pm. Emergent transfers should only involve patients who are transferred to the MICU/CCU or need telemetry.

Background:  Currently, a patient is transferred from a non-internal medicine service to an internal medicine service only through the involvement of the general internal medicine consult team (GIM). For a patient who is already receiving a consult through an internal medicine subspecialist, the extra step of involving GIM is unnecessary. For a patient who is not currently receiving any treatment from an IM subspecialist, GIM can provide the invaluable service of reviewing the patient’s current problems and status to determine if a transfer to an internal medicine service is warranted as well as to give recommendations on the treatment of the patient’s medical issues. 

Additional Notes:      

1. It is the consult service attending’s job to find an accepting IM attending. Unless the patient has previously been assigned to a firm, the Polk service, Carol Johns , or MEG, the consult attending will usually call the hospitalist unit first to find a bed. If the hospitalist unit is full or the patient needs a higher level of care than Hal-6 can provide, the consult attending will call the MEG attending.
           
2. The gen med consult service should not be involved with MICU or CCU transfers.
           
3. No transfer to IM can take place without an accepting attending agreeing to the transfer.
          
4. If the patient is already connected to a Firm, the Polk service, Carol Johns, or MEG, the patient should be transferred to that home service. Please call that attending covering that home service (ie. call the ACS). The home attending must accept the patient for the patient to be transferred to a Firm.
          
5. If this is a patient of a JHOC/Green Spring physician, the patient should be offered to that attending and will be transferred to that attending’s Firm.
          
6. If the patient is transferring from Halsted 3/Rehab, Psychiatry, Weinberg, or an outpatient clinic, the fellow or attending arranging the transfer must call admissions (5-5600) to accept the patient.
          
7. The medical shift coordinator needs to provide a bed and be involved in the process. To contact the medical shift coordinator, you can page them at 410-283-3989. You can also contact the medical shift coordinator through the pagerbox.com website. Simply type either 33989 or medical shift in the “search” box at the top of the pagerbox.com website and then you can text page the coordinator. Don’t forget to include your pager number.
          
8. A patient cannot be transferred by a fellow to MEG or Hospitalist service without the consult attending’s approval and help.
          
9. MEG, Garrett, and Nelson 5 are all names for the same service. It does not describe a place, it describes a service.
           

1. Subspecialist Guided Transfer

a. A subspecialist may want to transfer the patient to the Hospitalist Service or a Firm.

i. The subspecialty fellow will discuss the case with the attending covering the general medicine consult

1. If the patient is a Firm patient, the fellow should discuss the case with that Firm’s ACS

2. If the patient is a Firm faculty patient, the fellow should discuss the case with the specific Firm faculty member.

ii. The general medicine consult attending will agree to the transfer to either the MEG or to the Hospitalist Service.

iii. The subspecialist or subspecialty fellow will call the medical shift coordinator (on pagerbox.com 3-3989) to inform shifty of the transfer.

iv. The subspecialist or subspecialty fellow should inform the MEG intern/resident if applicable. The shift coordinator will know who the intern is.

v. The shift coordinator will inform the charge nurses of the transferring and accepting floors.

vi. The subspecialist or subspecialty fellow will inform the transferring physician that the patient has been accepted.

vii. The transferring physician will dictate a stat discharge summary and/or write a transfer note.

b. The subspecialist may elect to transfer the patient to his/her own subspecialty service (i.e., Carol Johns or MEG)

i. The subspecialty fellow will discuss the case with the subspecialty attending, and the subspecialty attending will agree to the transfer.

ii. The subspecialist or subspecialty fellow will call the medical shift coordinator (on pagerbox.com 3-3989) to inform shifty of the transfer and to discuss bed availability.

iii. The subspecialist or subspecialty fellow should inform the Carol Johns or MEG intern/resident if applicable. The shift coordinator will know who the intern is.

iv. The shift coordinator will inform the charge nurses of the transferring and accepting floors.

v. The subspecialist or subspecialty fellow will inform the transferring physician that the patient has been accepted.

vi. The transferring physician will dictate a stat discharge summary and/or write a transfer note.

c. The subspecialist or subspecialty fellow may believe that the patient needs to be transferred to the MICU or CCU.

i. The primary team should call the MICU/CCU fellow.
ii. If the MICU/CCU fellow accepts the patient, the ICU fellow should call the shift coordinator and inform the MICU/CCU charge nurse that the patient has been accepted. If the MICU/CCU fellow believes the patient does not meet that level of care, please refer to to the first or second option

iii. The transferring physician will dictate a stat discharge summary and/or write a transfer note.

2. The Gen Med Consult attending may elect to transfer the patient to the hospitalist service or MEG.

a.       The GIM consult attending will discuss the case with the Hal-6 hospitalist or the MEG hospitalist.

b.      The hospitalist will determine if the level of care is appropriate and will accept the patient to Hal-6 or MEG that business day unless beds are unavailable. If beds are unavailable, a service will take the patient the next business day.

c.       The GIM fellow will call the medical shift coordinator to inform shifty of the transfer.

d.      The shift coordinator will inform the charge nurses of the transferring and accepting floors.

e.       The GIM fellow will inform the transferring physician that the patient has been accepted.

f.       The transferring physician will dictate a stat discharge summary and/or write a transfer note.

Helpful Numbers and Websites:

Medical Shift Coordinator Pager- 410-283-3989 (also found on pagerbox.com under medical shift or by pager number)

MICU- 410-955-5570

CCU- 410-955-5572

Hospital Operator- 410-955-5000

Nelson 5/MEG Resident Office- 410-614-0218

Carol Johns Resident Office- 410-955-2543

Hal 6 nursing station- 7-3127

Hospitalist Pager- 3-2648

Hospitalist Cell Phone- 443-248-4651

                                                 
Revised, June 2009