TRANSFER & REFFERAL POLICY
PURPOSE:
To provide guidelines and to ensure safe and appropriate transfer of the patient with
minimal risk.
SCOPE:
This policy is applicable for patients who need to be transferred from wards,
departments, Emergency Room within the Hospital, to diagnostic facilities and to other
hospital facilities.
RESPONSIBILITY:
Treating Consultant, Duty Medical Officer, Emergency Medical Officer, Ward Nurse,
Ward boy, and Ambulance Drivers
DEFINITIONS:
STABLE:
Patients who have stable blood pressure and pulse, oral or intramuscular (IM)
medications and be breathing on their own. They may have a normal or reduced level of
consciousness, but should be stable at that level.
UNSTABLE:
Patients who require an intensive care level of monitoring of their vital signs (pulse.
respiration, blood pressure) or require the bedside capacity to intervene in anticipation
of a possible rapid decline in their condition are not considered stable. Patients with
low, extremely high, or rapidly fluctuating blood pressure are not stable. Patients
requiring continuous cardiac monitoring and/or the potential for cardiac resuscitation
capability are not stable.
POLICY
Clinical Staff of the hospital shall be trained in BLS protocols and staff of ER & ICU are
Trained in ACLS protocols
While transferring the patient within the hospital or to the other services patients
privacy & confidentiality to be taken care
INTRA HOSPITAL TRANSFER:
TRANSFER OF PATIENT FROM EMERGENCY ROOM TO OPERATION THEATRE (OT)
Patients who are critical and require immediate surgical intervention are transferred to
OT from the emergency room.
Patient shall be accompanied by the emergency nurse and emergency medical officer/
Intensivist. , the patient is handed over to the OT Nurse along with their case file.
Before shifting the patient from ER to OT, concerned nurse will be documenting the
patient shifting information in the patient shifting information sheet / Nurses Notes.
Staff accompanying in transfer of unstable patient shall be trained in ACLS.
EMERGENCY ROOM TO INTENSIVE CARE UNIT ( ICU ):
Patients who are critical and require immediate intensive care are transferred to ICU. ER
nurse MUST confirm the availability of bed before transferring the patient.
Patient shall be accompanied by the ER nurse and emergency medical officer, the
patient is handed over to the ICU doctor/ ICU registered nurse along with their case file.
Before shifting the patient from ER to ICUs, concerned nurse will be documenting the
patient shifting information in the patient shifting information sheet / Nurses Notes.
WARD / ICUs to OT
Patients who are undergoing surgery will be shifted to OT. Before shifting the patient
ward/ICU nurse MUST confirm the readiness of OT from the OT Nurse and
Information to be conveyed to the PRE of the concerned floor.
The patient for surgery shall be shifted along with their case sheet and duly completed
pre-operative checklist, relevant X-Rays, C.T. Scans and MRIs all other investigation
reports by a registered nurse and accompanied by the relative of the patient.
Before shifting the patient from Ward / ICU to OT, concerned nurse will be documenting
the patient shifting information in the patient shifting information sheet.
TRANSFER OF PATIENT FROM OT TO POW / ICUS / WARDS
OT Nurse / OT technician shall inform POW / ICU nurse that patient is to be shifted from
OT to POW/ ICU. Before shifting the patient from OT to ICUs / POW / Wards, concerned
nurse will be documenting the patient shifting information in the patient shifting
information sheet.
For ICU patient’s anaesthesia resident and technician shall accompany patient and hand
over to concerned nurse / ICU doctor on duty.
When the patient is fully conscious and follows the command, with the written order of
the anaesthetist, patient is shifted to the concerned ward.
TRANSFER OF STABLE PATIENT FROM ER TO WARD , WARD TO DIAGNOSTIC SERVICES
Patients who are diagnosed with stable vital signs and does not require immediate
intensive care shall be admitted to ward .These transfers shall be made only after
receiving written orders from treating doctor.
Before shifting the patient from ER to Wards, concerned nurse will be documenting the
patient shifting information in the patient shifting information sheet.
Patient once stabilized in the emergency shall be transferred along with their case file to
the concerned ward accompanied by the staff nurse & ward boy.
INTER HOSPITAL / DIAGNOSTIC TRANSFER:
EMERGENCY ROOM OR WARDS TO DIAGNOSTIC CENTERS:
In case of some of the diagnostic facilities are not available within the hospitals, patients
are transferred to such facilities for undergoing such diagnostic evaluations.
The diagnostic centre- where the hospital has agreement (MOU) with Vista labs, prior to
the patient’s transfer, the nurse or duty medical officer / PRE shall confirm the
appointment and record all Information requested on the appropriate document. In
addition, the transferring nurse shall review orders written 24 hours prior to transfer to
ensure that all orders have been taken off.
Before sending the patient, the emergency department or the ambulance control room
is informed who makes the necessary arrangements for ambulance and staff.
In case of critical patient nurse and medical officer, shall accompany the patient long
with their case file / transfer summary
TRANSFER OF PATIENT TO OTHER HOSPITAL:
Patients who do not match organizational resources, both in emergency as well as non
emergency situations are transferred to other hospital after providing first aid to the
patient.
On duty medical officer / PRE inform the patient’s relatives and makes necessary
arrangements for ambulance and staff required for transferring the patients.
Prior to the transfer of the patient the Medical Officer informs the other hospital
regarding the shifting of the patient to their facility. Transfer summary containing
information pertaining to the patient’s complaints, diagnostic made and treatment
given is prepared and given to the attendant accompanying the patient. Trained BLS
nurse accompanies the patients to the other hospital, in case of critical patients; a
medical officer along with a nurse accompanies the patient.
REFERRAL
Patients who do not match organizational resources, both in emergency as well as non
emergency situations in such cases the decision to refer a patient for consultation to
other clinical specialty shall be taken by the primary treating consultant of the patient in
Coordination with CEO.
Concerned consultant shall be giving consultation referral slip containing details of the
reasons for referring and the same is attached in the patient’s case file.
The consultant referring the patient to the identified external healthcare institution shall
fill a referral slip indicating the diagnosis, treatment given, condition of the patient,
investigations / procedures if any undertaken by the patient etc.
RECORDS
Transfer Summary
Patient shifting information sheet
