Transfer the patient from the hospital. On the procedure for transferring patients from one medical institution to another

From one medical institution to another is carried out for medical reasons. Moreover, in this situation there may be two scenarios for the development of events. In the first case, the transfer is carried out when any concomitant disease complicating the course of the underlying disease (cardiological, neurosurgical, neurological, etc.) or posing a threat to others (infectious, mental, etc.). In the second case, doctors insist on transfer if there is no technical ability to provide qualified assistance or if there is a life-threatening situation. In this case, the decision to transport the patient to another hospital is made by the administration, and on weekends - by the doctor on duty.

Often patients themselves, for one reason or another, want to transfer from one hospital to another. This desire does not always delight the management of the clinic in which. Before making a final decision, make sure that you will really feel better in the new medical facility, that the technical capabilities and qualifications of the staff allow you to provide quality care for your disease. If possible, collect information about the country you are going to transfer to.

Ask your doctor to give you detailed extract from the medical history, which will reflect information about your condition upon admission, the treatment performed and your current condition.

Contact the chief physician of the hospital where you want to. Ask your relatives to hand over your medical history extract during the manager's office hours. You can also send it by fax or . If the doctor is interested in your case, he will agree to hospitalization in his institution (subject to availability).

Tell your doctor that you have an agreement with the manager of another medical institution. After completing all the necessary documents, you will be transported there.

For work or study family circumstances– every year hundreds of thousands of people voluntarily or involuntarily change their place of residence, moving from one cities to another. What to do and where to go in such a situation?

Instructions

If you are moving for family reasons (relative, change in marital status, inheritance, etc.), collect everything Required documents to confirm them. To do this, contact institutions (hospital, civil registry office, notary office) that can issue you all the necessary certificates and certificates ( medical report, certificate of marriage/dissolution of marriage, certificate of entitlement to ).

All documents must be submitted first to the passport and visa service, at the place of work or study in your hometown, and then to the relevant authorities and institutions settlement where you plan to settle.

If your transfer is related to official needs, contact your place of work to review the order for your transfer (Form N T-5). Please note that such an order must be signed by both the head of the enterprise and the chief accountant.

Legal confusion surrounding the potential conflicts between the financial interests of the trauma center, the interests of public health, and the needs of the patient led to the creation of numerous pieces of legislation that, at the federal level, spurred congressional decisions aimed at protecting injured patients. "Act on Ambulance medical care and Childbirth Assistance (EMTALA) defines the obligations of trauma centers to provide care regardless of the patient's ability to pay.

EMTALA indicates, in relevant part, that the hospital in which there is a department is obliged to carry out the primary medical checkup each patient presenting to this department and determine whether the patient requires emergency medical attention. If the examination reveals a medical emergency, the hospital must provide such further medical evaluation and treatment “as may be necessary to stabilize the patient's condition” before the patient can be transferred elsewhere. The only reasons for transferring an unstable patient would be for medical reasons - if the hospital where the patient initially went does not have sufficient resources, while the other hospital to which the patient is transferred has more capacity to provide care.

The law Applies to all emergency situations, but focuses on trauma patients. The statutory designation of a hospital as a trauma center that meets specific published criteria for patient care has far-reaching legal implications. The hospital must have administrative staff, nurses, and physicians available to begin treatment of the patient at the level required by law or to provide resuscitation and prepare the patient for transport to a facility with better resources if required to provide care to the patient.

« Biopsy of the purse» as a factor determining the need to transfer a patient was thus eliminated. Delay in transferring a patient to a higher level of care can have legal consequences, as discussed above in Nevarez v. New York City Health Department.
This principle has been repeatedly confirmed.

Bitterman explains in detail the legal requirements for such translations. The responsible persons and attending physicians of the hospital from which the patient is transferred are required to issue a written statement certifying that the patient will receive better care at the receiving hospital, despite the risks involved in the transfer process. This determination is much easier to obtain if pre-established patient transfer agreements exist between the two trauma centers. These agreements may be part of an interhospital trauma system protocol.

Effective agreements about translation reflect the successful resolution of conflicts between medical workers, third party payers, hospital administrators and their legal representatives. A center referring a patient to another medical institution must confirm writing that the patient or the patient's legal representative has been informed of the hospital's obligations under EMTALA, and that the risks associated with the transfer are less significant than the risks associated with being at the referring hospital. If a delay is unavoidable, a reassessment of the patient's condition is necessary to ensure all parties are confident that transfer is still necessary.

Other problem occurs when the patient arrives at the emergency department independently or is transported by a third party. The average citizen has no knowledge of what resources are or are not available to a trauma center; Valuable time may be lost if an injured patient is transported to a facility that is understaffed or otherwise unable to establish correct diagnosis and treatment was carried out. California, along with other states, has attempted to address this issue by legislating when a health care facility may use the term "emergency care" in its name or advertising.

Private persons or organizations are prohibited from using this term - or other words that suggest that this person or the organization may provide emergency medical care - unless they meet minimum standards, including: having radiography equipment and a clinical laboratory serviced by full-time or visiting staff and available for immediate use; maintaining a database of medical specialists who can be contacted for referrals, consultations or special procedures; and the existence of transfer agreements with one or more hospitals providing emergency assistance general profile, on the basis of which patients in need of specific form medical care may be transferred without delay to another hospital to receive the appropriate level of care.

Availability medical indications for transfer implies that the referring center does not have the necessary personnel or equipment to provide the indicated therapy to the patient. Otherwise, the referring center is in violation of EMTALA. This fact, of course, creates the potential for liability if the referring center was found to have the necessary resources to treat injuries that were subsequently treated at the receiving center. For example, a trauma center that presents itself to the public as a medical facility capable of providing care for traumatic brain injury must have the appropriate resources and neurosurgeons available when a patient is admitted with such an injury in order to provide resuscitation and follow-up care. .

If so opportunity temporarily unavailable, the best solution for a trauma center is to have a pre-determined plan to divert patients to another hospital before they are brought to the center to avoid potential legal liability. This may reduce the income that the center would receive if it served the small number of patients who were referred to another facility, but this solution appears to be in the best interests of the patient and, in long term financially sound.

After confirmation that the transfer is made in the interests of the patient, and obtaining his informed consent, the transfer itself can be carried out directly. A requirement for the referring hospital is that the patient is optimally maintained in a stable condition and that an agreement has been reached with the receiving hospital to admit the patient. If a patient's initial assessment determines that the hospital is unable to provide medical care for such injuries, efforts should be focused on stabilizing the patient and promptly transferring him rather than on detailed and time-consuming diagnostic procedures. CT scan head is not particularly useful in diagnosing the causes of severe traumatic brain injury unless the center has a neurosurgeon; similarly, detailed pelvic radiography designed to determine the details of a complex acetabular fracture is not particularly useful if the center lacks core resources for orthopedic surgery.

If patient cannot be stabilized at the referring hospital, transfer to a facility capable of providing care for more high level, is permitted provided that the anticipated risk if the patient is not transferred exceeds the risk associated with the transfer. If the above requirements are met, the referring hospital will be protected from legal liability if the patient refuses the transfer. This decision was made by the Maryland Court of Appeals in the case of Davis v. Johns Hopkins Hospital. The case involved the following: The parents of a child who had previously been treated at Johns Hopkins Hospital for a life-threatening condition wanted to send the child back to the hospital when his condition worsened again. However, the hospital was not accepting emergency patients at that time and therefore diverted the ambulance helicopter transporting the child to another hospital that had the necessary resources. The parents did not agree with this decision and insisted that their child be admitted to Johns Hopkins Hospital. To comply with their request, hospital staff had to move several patients from the emergency department to other areas in order to be able to use the equipment needed to treat the child.

This delay, as the parents alleged in their complaint, caused serious neurological complications in the child. However, the court found that Johns Hopkins Hospital was correct because the hospital advised that it was not able to accept emergency patients at that time and had an agreement to alternative treatment in an institution of a similar level. The Court held that while a hospital generally has a duty to provide emergency care to patients who are admitted to the hospital with a condition requiring such care, a hospital is not required to provide emergency care unless it has adequate resources to do so.

Department of Health
dated 06/03/2009 N 482

Order
transfer of patients from one medical institution to another

The decision on the need for transfer is made by the attending physician, the head, and the council.

The issue of transfer must be agreed with the administration of the institution where the patient is transferred.

At night, weekends and holidays- the responsible doctor on duty - the manager (administrator) together with specialists from mobile emergency medical teams.

1. Transfer of patients in need of emergency medical care (both general somatic and specialized) from one hospital to another is carried out around the clock through the hospitalization department of the Emergency Hospital in daytime at the request of chief doctors or their deputies; and at night, weekends and holidays - at the request of the responsible doctors on duty and the administrator on duty by phone: 35-30-31, 35-02-07.

2. Transfer of a patient to another hospital for urgent reasons is carried out by specialized teams or teams intensive care. The decision on the transportability of the patient is made by commission (EXT - consultation) with the obligatory participation of the responsible doctor of the team who arrived to transfer the patient. If it is not transportable, an entry is made in the medical history.

3. Routine transfer of patients in need of specialized treatment, is carried out both on weekends and on holidays, with notification to the patient, if the patient can adequately perceive this information, as well as relatives, if they exist. When transferring, the full name is specified. specialists from medical institutions. The transfer is carried out according to the conclusion of specialists (full name) and an agreement between the chief doctors or their deputies through the SSMP by phone 35-30-31, 35-02-07 daily (except weekends and holidays) from 9 to 18 hours. The transfer of the patient can be carried out either by ambulance or by transport from the medical institution (if any) from which the patient is transferred.

4. Transfer from a general hospital to infectious diseases hospitals is carried out by agreement of the deputy. chief doctors on weekdays and duty administrators (on duty) indicating the full name, ambulance team and epidemiological number by calling 23-69-70.

5. When transferring patients from one hospital to another, a detailed extract from the medical history is drawn up. The extract from the medical history describes in detail the X-ray, ultrasound, ECG, and other studies performed, indicating the severity of the patient’s condition, the reason for transfer, the method of transportation, and hemodynamic parameters before transportation.

6. Health workers transferring patients must transfer the patient directly to the doctor on duty of the relevant department.

When additional medical care is provided to the patient during transportation, the data is entered into an extract from the medical history indicating the main parameters of hemodynamics and other important indicators.

7. Transfer from the State Healthcare Institution "VOKPB N 2, 4, 5" to the somatic department is carried out:

In the afternoon after approval by the heads of departments and deputy chief physicians;

At night and on weekends after agreement between the doctors on duty and the administrator on duty.

Hospitalization is carried out by a psychiatric ambulance team. The patient is transferred if there is an extract, a conclusion on transportability, and an indication of the need for individual supervision. An individual post is provided by a psychiatric hospital.

7.1. Transfer of patients from somatic hospitals to psychiatric hospitals is carried out after consultation with a psychiatrist:

During the day, these are psychiatrists from psychiatric dispensaries assigned to the corresponding medical institutions;

At night and on weekends - doctors from psychiatric emergency medical teams.

The patient is transferred if there is an extract and a conclusion about transportability.

8. Transfer from TB dispensaries to somatic departments is carried out according to emergency indications:

In the afternoon after agreement with the heads of departments and the deputy chief physician;

At night - with the administrator on duty.

9. Transfer from somatic hospitals and from the emergency room to anti-tuberculosis dispensaries after the diagnosis of Tuberculosis is established is carried out after consultation with a phthisiatrician at the tuberculosis dispensary assigned to the medical institution.

10. Transfer of drug treatment patients from general somatic hospitals to drug treatment hospitals.

Indications:

Acute psychotic state with psychomotor agitation, caused by a syndrome of dependence on alcohol or psychoactive substances, not complicated by somatic or neurological pathology;

The decision to transfer to daytime hours is made after consultation with a narcologist on a territorial basis and an agreement with the deputy chief physician for medical affairs;

IN evening time, weekends and holidays - after consultation with an emergency medical psychiatrist and agreement with the responsible doctor on duty at the State Health Institution "Voknd".

Contraindications:

States, life threatening patient due to the development of severe somatic or neurological disease in need of resuscitation measures. In these cases, the patient is treated in a somatic hospital, receiving treatment for the underlying disease and, if necessary, treatment for drug addiction disease based on consultations with the district narcologist.

10.1. Transfer of drug treatment patients from the State Health Institution "Voknd" to general somatic hospitals.

Indications:

Acute and severe somatic and neurological disorders;

Injuries and illnesses of patients requiring qualified medical care.

Transfers of patients from one medical institution to another are carried out upon provision of a detailed extract from the medical history indicating the anamnesis, clinical status of the patient, clinical laboratory data and X-ray examination, consultations with specialists, a list of medical and resuscitation measures carried out, reflecting the dynamics of the disease and the patient’s condition, indicating the diagnosis upon admission to a medical institution and upon admission to a medical institution and upon transfer to a narcological hospital with a full indication of the doctor’s full name in agreement with the administration of the relevant medical institution.

11. Transfer of patients from one hospital to another is noted in the hospitalization log and in the medical history.

Transfer of a patient to another department or another health care facility can be initiated by himself or his attending physician. In this case, the translation must be properly documented and prepared in advance.

Not everyone and not always, having been admitted to the hospital in one department, are discharged from the same department. We mean that transferring patients from one department to another, as well as from one medical institution to another, is normal phenomenon and a fairly common practice today. Transfers of patients are associated, firstly, with insufficient medical competence demonstrated at initial stage treatment, when patients are assigned to one or another department of the hospital. Secondly, the transfer of the patient may be dictated by the wishes of himself or his relatives and official representatives. No one can force a patient to receive treatment in one place or another. Accordingly, patients often initiate a change of department, and more often, a change of medical institution. Note that in most cases, patients leave public health facilities and continue treatment in private, commercial medical clinics.

The basis for officially transferring a patient is the transfer epicrisis. In general, the epicrisis itself seems, it must be said, a very ambiguous concept. For example, a staged epicrisis is drawn up for a patient by doctors every three days of his treatment. Upon discharge, the patient receives a discharge summary, issued in the form of a special medical certificate. Let us note that sometimes when transferring from a public health facility to a private one, it is not the transfer epicrisis that is drawn up, but the discharge summary. This is due to the fact that the state health care facility may, in some cases, decline responsibility for the consequences of the patient’s transfer. Having issued a discharge summary, the medical institution ceases its interaction with the patient. However, if a person is confident in his decision to transfer, then the lack of a medical certificate will not stop him.

Doctors themselves may recommend transferring the patient either if they discover new symptoms that require treatment in specialized settings, or if the patient exhibits symptoms that are potentially dangerous for people around him (roommates and doctors). These symptoms may be due to mental disorders patient, with infectious carriage, etc.

Please note that in any case, the attending physician, as part of the transfer of the patient, is obliged to give him a detailed statement about the treatment performed on him, the results of this treatment and the current condition of the patient. It is illegal for a doctor to refuse to provide such a statement. Patients and their relatives need to remember this in order to be able to protect their legal rights if necessary. A refusal to discharge or a refusal to discharge a patient, transferring him to another department or health care facility can be challenged first at the level of the chief physician of a given medical institution, and then at the level of the municipal, district and federal structure of the health care system. Finally, no one has also canceled the right of any person to apply for restoration of their violated rights to the court or to the Prosecutor's Office.

In conclusion, we note that before transferring, you should make sure that the other department or other health care facility is really ready to accept the new patient. This is important in order to avoid a situation where the patient finds himself “in his own interests,” that is, already discharged, but not yet admitted anywhere. In this regard, it is better to immediately issue the necessary medical certificates about the patient’s admission to another medical institution or department, and then deal with the physical movement of the patient.

In general, it must be especially emphasized that compliance with all formalities and precautions in this case plays an extremely important role!

The compulsory medical insurance policy guarantees the right to receive free medical care for children, and it is implemented in practice on a territorial basis. The child is observed by the local doctor of the children's clinic closest to the place of residence, which is assigned to this territory. She receives money from the insurance company that issued the child's compulsory medical insurance policy. For parents who decide to change the clinic where the dispensary observation the child has a legally enshrined right to do so. But for what reasons do citizens change medical institutions? How to implement this procedure? What actions to take and what documents to prepare? We will answer these questions in this article.

Why change the clinic?

The reasons for transfer to another clinic may vary. For example, a change of place of residence, as a result of which it becomes inconvenient to travel to an appointment, a lack of pediatric specialists necessary to treat a child, low quality of medical services, or banal dissatisfaction with the pediatrician: his competence, character, behavior. But whatever the reasons for leaving the clinic, it is necessary to take into account that when called, only the local doctor assigned to the given area comes to see a sick child free of charge. A new pediatrician in another clinic will not be paid for a call at someone else’s site: when a child is transferred, the right to call a doctor at home for free is actually lost.

Legislative basis for changing medical institutions

It is established by law that any citizen of Russia insured in the compulsory medical insurance system has the right to change the attending physician and the medical institution itself. This right of choice and the procedure for transferring to another children's clinic are legislatively enshrined in three government documents:

1. Federal Law of November 29, 2010 No. 326-FZ.
2. Law “On the fundamentals of protecting the health of citizens in the Russian Federation” dated November 21, 2011 No. 323-FZ.
3. Order of the Ministry of Health of the Russian Federation dated December 21, 2012 No. 1342n “On approval of the Procedure for choosing a medical organization by a citizen...”.

Art. 16 of the first law determines the right of the insured to choose an institution to receive free medical care. The same article of the law states that the policyholder has the right to change medical institutions only once a year. Article 21 of the second regulatory act confirms the right of policyholders to choose a medical institution and a doctor to receive free medical services. The order regulates the sequence of actions when applying to the selected clinic: writing an application; presentation of a passport, compulsory medical insurance policy; indication of place of registration and place of residence, address of the institution where medical care was previously provided.

Procedure for transferring a child to another clinic

The first problem that must be solved when changing clinics is finding a new medical institution and a doctor willing to observe the child. It is necessary to obtain his consent because most of the reasons for refusing registration are the overload of children's doctors. Next you need to proceed according to the following algorithm:

• Contact your clinic at your place of registration with a request for absenteeism. To do this, you need to write an application addressed to the chief physician;
• If the answer is positive, a child's bag will be issued. Medical Card and an absentee ballot (the institution no longer receives money from this insurance policy, and the child is not served in it for free);
• A package of documents is provided to the selected clinic:
  • a statement that explains the reason for choosing this institution and the doctor with whom the child will be observed;
  • compulsory medical insurance policy issued for the child at the mother’s insurance organization;
  • birth certificate or passport (from 14 years of age) of the child;
  • absentee ballot from the previous place of dispensary observation.
• After signing the application by the head doctor, you can use the services of the selected medical institution;

If the former institution refuses to detach or the new one does not agree to be registered, the simplest solution is to contact the insurance agent of the organization that issued the MHI policy to the child. He will tell you how to properly transfer the child to another medical institution. To exercise your rights, it is better to have on hand photocopies of your appeals with the resolutions of the failed chief doctors. They must indicate the reasons for the refusal.

How to change pediatrician at the clinic?

The legal basis for changing a pediatrician is enshrined in Article 30 of the Fundamentals of Legislation Russian Federation on the protection of the health of citizens" of the Supreme Court of the Russian Federation of July 22, 1993 No. 5487-1, which talks about the right of patients to choose a doctor. But in practice, things are not so simple. First, you need to find a new pediatrician who will agree to supervise a child living in “foreign” territory. It is best to take written consent from him, since the chosen doctor may simply be overloaded and will not be able to give the child due attention. Secondly, you must submit a written application to the administration of the institution (head of department or chief physician). The application should clearly state the reasons for the decision to change doctors. A complaint against a representative of a medical institution is a right enshrined in Art. 30 “Fundamentals of Legislation”. In case of refusal, it is necessary to request a written response from the administration with reasons and send a complaint to the Department of Health.

Even after switching to the chosen doctor, only the local pediatrician will visit the child free of charge. All other options will have to be paid for. Full package free services By compulsory medical insurance policy is possible only if the child is assigned to a medical institution at his place of residence. When a child is removed and transferred to another clinic or to another doctor, parents must be prepared to pay for part of the services themselves.

Conclusion

The right to transfer a minor to another medical institution and change the attending physician is enshrined in law. The procedure for such a transfer is similar to the detachment of the adult population from the clinic. First of all, you need to write an application at the selected institution, then go through the absenteeism procedure in the old one and receive an absentee ballot, and then with this coupon and other documents go back to the selected health care facility.