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Based on review of 13 medical records, and interview, the facility failed to accept a requested transfer for 1 of 13 patients (#12) that was injured in a motor cycle accident and received blunt chest trauma, and fractures of ribs and clavicle. A monitored bed was requested, in order to be able to provide immediate care should the patient suffer respiratory difficulties, as the patient had lung contusions, and a chest tube for a pneumothorax. Refer to findings at TAG A-2411.

Based on review of 13 medical records, and interview, the facility failed to accept a requested transfer for 1 of 13 patients (#12) that was injured in a motor cycle accident and received blunt chest trauma, and fractures of ribs and clavicle. A monitored bed was requested, in order to be able to provide immediate care should the patient suffer respiratory difficulties, as the patient had lung contusions, and a chest tube for a pneumothorax.

The findings include:
1. Patient #12 is a 61 year old who was involved in a motor cycle accident in which the patient was going between 40 and 45 miles per hour. The patient laid the motorcycle down, and sustained injuries including blunt chest trauma with rib and clavicle fractures, and a laceration to the elbow. When the patient was being taken to the emergency room, the patient ' s breathing became labored and the paramedics had to place a rebreather mask on the patient which eased the patient ' s breathing.
The patient was seen in the emergency room of hospital #1, on 10/8/2010, and the physician ordered lab tests as well as x-rays. The physician ordered lab tests and x-rays to be done. It was noted that the patient had subcutaneous emphysema (presence of air in the subcutaneous tissue), in the left chest area, with left third and fourth rib fractures which were minimally displaced, and left bibasilar atelectasis versus contusions. The patient also had a comminuted fracture ( a fracture where the bone is crushed and/or splintered into multiple pieces) of the left clavicle. The patient had a laceration to the left elbow, but no fracture. Vital signs were temperature 97.9, pulse 99, respirations 19 and BP 153/86.
During the CT, it was noted that the patient had a 10-15% pneumothorax on the left side and the patient was brought emergently back to the emergency room. The physician placed a chest tube in the left side with good results. X-ray showed that the pneumothorax had resolved.
After the patient was stabilized, the physician at hospital #1, called hospital #2 requesting a monitored bed . It was stated that the patient was not a trauma alert. The ED physician requesting transfer spoke to the trauma surgeon on call at hospital #2 with transcripts provided by hospital #2 to reveal calls at 2335, 2344, and 2349 hours to request transfer assistance and physician contact between the ED physician (hospital #1) and the trauma surgeon (hospital #2) on 10/8/10 at 2349 hours. The patient ' s condition was discussed and transfer to hospital #2 was denied with the reason given for denial as the trauma surgeon at hospital #2 did not feel that the patient met trauma criteria and he could do nothing more for the patient than they were doing at hospital #1.
The physician at hospital #1 requested transfer given the mechanism of injury and given the status of the breathing with the associated blunt chest trauma. The transfer was still denied. The physician from hospital #1 tried to explain that they did not have the interventional services that might be necessary in the event that the patient got sicker. The transfer was continued to be denied. The facility refused to accept from Hospital #1 (a referring hospital)an appropriate transfer of patient #12 who required the specialized capabilities of Hospital # 2 which had the capacity to treat the patient on 10/8/2010.
The physician from hospital #1 then called a second trauma facility in Orlando and the patient was accepted with the request that s/he be intubated. The physician from hospital #1 agreed as while they were sitting there, the patient continued to decompensate. The patient was intubated without incident, and then flown to the trauma facility in Orlando.
Interview on 10/28/10 at 11:40am with a physician in the emergency department was done regarding trauma transfers with the following revealed:
1. How do you determine if a patient can transfer to this facility from another facility?
I would ask the physician why he felt the patient should come to this facility, to provide a higher level of care. The patient must meet the adult trauma guidelines.

2. What is physician discretion? We don ' t use that here.

3. Normally how do you get the call for a transfer from other hospitals?
Most of the time the call comes through the the transfer center who keeps a log of all of the calls.
If the patient does not meet criteria for transfer, I will discuss this further with the trauma surgeon and sometimes will call the facility back. Sometimes, facilities call the ED directly, and the transfer center does not get involved in the discussion.