Protocol for Transferring Patients from Skilled Nursing Facilities to Emergency Rooms

Pre-Transfer Decision-Making

The American College of Critical Care Medicine recommends that the SNF must establish physician-to-physician communication with the receiving emergency department before transfer, with the referring physician providing a complete description of the patient's condition and confirming that appropriate resources are available at the receiving facility 1
The Society for Healthcare Epidemiology of America indicates that transfer from an SNF to an ED is indicated when the resident is clinically unstable and the resident or family goals indicate aggressive interventions should be initiated 2
The Infectious Diseases Society of America suggests that transfer is also indicated when critical diagnostic tests are not available in the SNF, necessary therapy or the mode of administration of therapy are beyond the capacity of the SNF, comfort measures cannot be assured in the SNF, or specific infection-control measures are not available in the SNF 2

The American Heart Association recommends that the referring physician must identify and contact an admitting physician at the receiving hospital to accept the patient in transfer before the transfer occurs, and provide a full description of the patient's condition, request advice concerning treatment and stabilization before transport, and confirm that appropriate higher-level resources are available at the receiving facility 1
The American College of Critical Care Medicine suggests that a nurse-to-nurse report must be given by the referring SNF to the appropriate nursing unit at the receiving hospital, or alternatively by a transport team member at the time of arrival 1

The American College of Critical Care Medicine recommends that a copy of the medical record, including a patient care summary and all relevant laboratory and radiographic studies, must accompany the patient 1
The American Diabetes Association provides sample transfer forms including a Universal Transfer Form and an Example of a Skilled Nursing Facility-to-Emergency Department transition document 4

The American College of Critical Care Medicine suggests that the SNF should begin appropriate evaluation and stabilization to the degree possible before transport to ensure patient safety during transfer 6
The Society of Critical Care Medicine recommends that nonessential testing and procedures should be avoided as they will delay transfer, and information and recommendations about stabilization can be requested from the accepting physician at the time of initial contact 6

The American College of Critical Care Medicine recommends that all critically ill patients undergoing interhospital transport must have, at a minimum, continuous pulse oximetry, electrocardiographic monitoring, and regular measurement of blood pressure and respiratory rate 1
The American College of Critical Care Medicine suggests that selected patients based on clinical status may benefit from monitoring of intra-arterial blood pressure, central venous pressure, pulmonary artery pressure, intracranial pressure, and/or capnography 1