A Successful Patient Transfer

Indexing Title: MESANICO’S MAR [15-04]
MAR Title: A Successful Patient Transfer
Date of Medical Observation: October 2015
Tag: Patient’s recovery after being transferred to a different institution
Category: Professional / Ethical – Reinforcement
About 6 months ago we received a 47-year-old male at the Emergency Room who sustained a lacerated wound on his right arm secondary to contact with a grinding machine. The injury was so severe that we immediately brought the patient to the Operating Room to do surgery. Upon examining the wound we saw that aside from extensive tear on the muscles of his right arm, we also noted that the brachial artery had been transected. After approximately 4 hours of attempting to repair the blood vessel and failed, we decided that would be better to transfer the patient to a different institution unfortunately, to one with more adept physicians with experience on our present case. We were able to coordinate the patient to another government institution and the transfer was completed within an hour. Days and weeks had passed and I had not been able to follow-up on the outcome of the patient, up until I had my rotation at that same government institution where we transferred him. I inquired about the patient with my co-resident at the other hospital to which his reply surprised me. It was he himself who attended to our patient, along with a specialized physician with vascular surgery. They were able to repair the injury and that the patient had made a full recovery and was discharged a week after. I felt relieved and very grateful for what he had done and told him casually that if ever such a case would be encountered again that I would contact him. 
(Physical, Psychosocial, Professional / Ethical)
(Discovery, Stimulus, Reinforcement)
Being in one of the main hospitals and at the center of Metro Manila, we attend to a vast number of patients every day, from those patients with simple lacerations or other physical injuries, to those diagnosed with acute appendicitis needing surgical operation right away. Ideally, we are tasked to treat all these patients, give them high quality and immediate medical attention. However not all may be fortunate to receive such treatment. There may be occasions where a sheer number of patients are currently being seen at the Emergency Room. Another may be due to a long queue for operation, leading to delay in treatment and possible complications. For such instances, sometimes the best option for these patients may be to transfer to a different institution where they can be seen and assessed immediately, avoiding delay of any needed treatment. We can offer to these patients to coordinate their transfer, which may give us the opportunity to follow-up on the current status of the patient and lead to a more immediate course of medical attention as compared to if the patient were to transfer from one hospital, where he or she may possibly be not accepted right away, to another hospital by themselves. Transferring patients to a different hospital may be in the best interest of the patient. As long as we are able to facilitate it properly and explain the process to both the patient and his relatives completely then we can consider this as doing more aid than harm.
ROJoson’s Notes (15nov22):
Transferring patients to another hospital is recommended if it will be in the best interest of the patient from the point of view of would-be referring physician.
Some indications consist of the following:
1) The second hospital has the expertise to handle a certain medical condition or situation as cited in the narration;
2) The first hospital lacks a certain diagnostic or treatment equipment needed to manage the patient and if it is to the patient’s best interest (based on the judgement of the would-be referring physician) that the patient should have access to this certain equipment (of course, as long as the patient can afford the entailed expense);
3) There is a long queue in the first hospital in such there will be a significant delay in medical management;
4) There are significant renovation of the first hospital; and
5) There is significant impairment in the quality and patient safety management system in the first hospital.
For continuity of care, at least to show an interest in the patient’s welfare, the referring physician should have a follow-through information on the patient transferred, from feedback from the patient or relatives  and/or from the physicians taking care of the transferred patients.
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