Inter-Hospital Transfer to UBCH Ortho - Updated June 2022
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A process is proposed to allow safe inter-hospital transfer of Orthopedic Reconstructive Surgery (ORS) patients to UBCH, via the BC patient transfer network (PTN), with the intent of offering them expedited surgery on elective slated time. This proposal is intended to lay out the conditions under which such an initiative can be done safely.
First, a Vancouver Acute (VA) orthopedic reconstructive surgeon will have to accept such a patient transfer. The surgical indications for which patients would be candidates for transfer from other hospitals to have orthopedic surgery at VA are within the purview of the Division of Orthopedic Reconstructive Surgery.
After the decision has been made to accept this patient transfer with a view to offering them surgery, a comprehensive review of the patient’s current state of health, as well as past medical history, will be done by the accepting orthopedic surgeon or their designate. This will involve direct communication with the most responsible physician (MRP) at the transferring hospital, as well as a comprehensive review of information available from CareConnect.
The information that will be reviewed must include all cardiology studies (including echos, cardiac caths, MIBI scans, ECGs and Holters), pulmonary studies (including sleep studies, CT scans, Xrays, PFTs), a detailed review of bloodwork, and any existing consults by CPAS, psychiatry, geriatrics, neurology or endocrinology. This will help to make a determination whether the patient to be transferred meets the current UBCH OR Suite Patient Selection Criteria (PSC). The PSC will be dated and supplied to ORS by a representative of the VADA executive, and will be updated on a regular basis. The most recently dated version of PSC will be considered to be the valid version.
1. If the patient meets the conditions in the PSC, a full consult must be dictated to PCIS by the ORS designate, which will include comprehensive information available from CareConnect.
2. The consult will also fully summarize the patient’s non-orthopedic medical problems, treatment of the same, and a full list of current medications and dosages.
3. It will also include an explicit assessment of whether in the opinion of the writer the patient meets the PSC.
This must all be completed before patient transfer.
It is understood that this may take time, but that it is also a necessary condition for patient safety. After this dictated assessment is completed, steps may be taken to initiate the transfer of this patient to UBCH.
If the patient does not meet these criteria, steps should be taken to transfer the patient instead to VGH. Medical conditions which absolutely exclude patients from having their surgery done at UBCH currently include but are not limited to: dialysis dependent renal failure; implanted AICD; documented coagulation disorder; BMI ≥ 60; significant valvular heart disease; significant CAD; chronic pain and opioid use exceeding the criteria on the most recent guidelines; current usage of street opioids; and surgery likely to benefit from the postoperative use of epidural analgesia. The UBCH OR Suite Patient Selection Criteria (PSC) will be used to assess every patient who is a candidate for transfer.
1. The ORS will be the admitting service at UBCH, and will be the MRP charged with assessing the patient on admission, admitting them to a unit with the appropriate level of care, and writing the admission orders.
2. The MRP or designate will on admission refer all such transferred patients to the Internal Medicine Consult Service at UBCH (which currently offers seven-day coverage) to assist in expeditiously assessing and optimizing the patient’s health. The intent is that if studies such as echocardiograms are indicated, this could then be organized early, before the patient is assessed by VADA, which will benefit the patient by getting them ready for surgery faster.
3. If the patient is admitted during working hours on a weekday, the admitting physician will let the UBCH in charge anesthesiologist (U1) know the details of this admission. This will involve direct physician to physician contact.
4. If the patient is admitted on a weekend or stat day, the admitting physician will make sure the details of the admission are made known on the next weekday to the UBCH in charge anesthesiologist (U1). This will involve direct physician to physician contact.
U1 will be responsible for arranging that any transferred patient is assessed by anesthesiology after they have been assessed by internal medicine. Once the anesthesiology assessment is completed, the patient will be discussed by U1 with the ORS, at which time a joint decision will be made as to when and where the surgery will be done.
All suitable transferred ORS patients at UBCH shall, after approval, be booked on an elective slate. Revisions need to start by 1030 AM, and are not appropriate for swing rooms.
The safe implementation of this initiative depends on contributions by among others VADA, UBCH Nursing, the UBCH HAU, CPAS, UBCH Internal Medicine and UBCH Cardiology, but above all on the ORS, who will have to internalize and understand the UBCH OR Suite Patient Selection Criteria (PSC).
It is understood that from time to time patients may be transferred to UBCH who on review need their care at VGH instead. These patients will be transferred to VGH from UBCH, to have both their surgery and recovery there.
All transferred patients will be reviewed jointly by representatives of VADA and ORS on a quarterly basis, with input from UBCH Nursing, to determine how the process can be improved.
This initiative will be reviewed by the VADA Executive and the ORS one year after its inception to determine whether it should continue, and if so what resources are required for its safe continuation.
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