Appropriate Interhospital Patient Transfer

Revised and approved by the ACEP Board of Directors February 2009, February 2002, June 1997

Revised with title "Appropriate Interhospital Patient Transfer" September 1992

Originally approved by the ACEP Board of Directors as a position statement titled "Principles of Appropriate Patient Transfer" September 1989

The American College of Emergency Physicians (ACEP) believes that quality emergency care should be universally available and accessible to the public. For patients evaluated or treated in the emergency department (ED) who require transfer from the ED to another facility, ACEP endorses the following principles regarding patient transfer.

  • The optimal health and well-being of the patient should be the principal goal of patient transfer.
  • Emergency physicians and hospital personnel should abide by applicable laws regarding patient transfer. All patients should be provided a medical screening examination (MSE) and stabilizing treatment within the capacity of the facility before transfer. If a competent patient requests transfer before the completion of the MSE and stabilizing treatment, these should be offered to the patient and documented. Hospital policies and procedures should articulate these obligations and ensure safe and efficient transfer.
  • The transferring physician should inform the patient or responsible party of the risks and the benefits of transfer and document these. Before transfer, patient consent should be obtained and documented whenever possible.
  • The hospital policies and procedures and/or medical staff bylaws should identify the individuals responsible for and qualified to perform MSEs. The policies and procedures or bylaws must define who is responsible for accepting and transferring patients on behalf of the hospital. The examining physician at the transferring hospital will use his or her best judgment regarding the condition of the patient when determining the timing of transfer, mode of transportation, level of care provided during transfer, and the destination of the patient.
  • Transfers are effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer.
  • Agreement to accept the patient in transfer should be obtained from a physician or responsible individual at the receiving hospital in advance of transfer. When a patient requires a higher level of care other than that provided or available at the transferring facility, a hospital with the capability and capacity to provide a higher level of care may not refuse any request for transfer.
  • An appropriate medical summary and other pertinent records should accompany the patient to the receiving facility or be electronically transferred as soon as is practical.
  • When transfer of patients is part of a regional plan to provide optimal care at a specialized medical facility, written transfer protocols and interfacility agreements should be in place.

To ensure optimal patient care, nonhospital satellite medical facilities should abide by transfer standards much the same as those outlined above.  Laws and regulations relevant to the Emergency Medical Treatment and Labor Act1 (EMTALA) exist in many states.  Physicians who participate in patient transfer decisions should be aware of applicable state-specific transfer laws and regulations.

1 The Emergency Medical Treatment and Active Labor Act, as established under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 USC 1395 dd) and 42 CFR 489.24; 42 CFR 489.20 (EMTALA regulations).


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