At times of high capacity at the BCH MB campus, it may be necessary to refer patients from the Mission Bay ED to an inpatient unit at BCHO. This should be considered if:
- the wait for an inpatient bed at MB is longer than 8 hours
- the MB ED has 4 patients boarding with inpatient orders
- BCH MB is at over 90% capacity with few anticipated discharges
When the hospital approaches maximum capacity, the CPP should notify the ED attending, ED charge RN and the admitting Pediatric Hospitalist that incoming ED patients should be screened for admission to BCHO.
Patients that are excluded from transfer and should be admitted to BCH MB:
- Oncology and BMT
- Liver and renal transplant patients
- Adolescent Medicine patients
Ideally, patients that transfer are ones without an extensive history with sub specialists at Mission Bay. However when the hospital is at maximum capacity, each ED patient should be triaged by the ED attending, Pediatric Hospitalist and sub specialty MDs and assessed for possible admission to BCHO. This triage keeps beds available at MB for patients that cannot receive care at BCHO and prevents the ED from filling up with admitted patients, reducing their ability to take walk-ins and emergency patients.
Procedure:
Once a patient is identified as eligible to transfer to BCHO, the ED attending can call the Peds Access Center and request to speak to the BHCO Hospitalist to give sign out. The Peds Access RN adds the patient to the BCHO transfer center board and arranges for transport, once the bed has been released by the BCHO Nursing Supervisor.
If the patient already has inpatient orders, they are under the care of the Pediatric Hospitalist Service. If a bed is not going to become available in a reasonable amount of time and the patient is eligible for transfer, the admitting MB Hospitalist can call Peds Access and request to be connected to the BCHO Hospitalist to give sign out and the process is the same as above.