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Based on medical record review, audio recording review, and interview, the facility would not accept the transfer of Patient #22 from an outside referring hospital despite the need of specialized Orthopedic Hand care. Failure to accept a transfer for higher level of care services can delay patient treatment and potentially lead to adverse patient complications and/or outcomes.

Findings Include:

Review of the Emergency Department (ED) Medical Record from Jones Memorial Hospital (JMH) dated 11/30/21 revealed Patient #22 presented to the ED at 04:18 PM with an 8-inch, priority 2 laceration of the left hand and forearm following a miter saw injury. Patient #22 presented with venous bleeding, metacarpal open fracture confirmed by X-ray, and a concern for tendon injury. The JMH ED Physician requested transfer of Patient #22 to Strong Memorial Hospital (SMH) for a higher level of care. Mercy Flight transfer transport was called at 04:33 PM but unavailable. The JMH ED Physician progress note dated 11/30/21 at 05:05 PM indicates Staff (Y), SMH Orthopedic Hand Surgeon "did not believe this injury required emergency management at a Trauma Center, rather he reminded me of the cost of transfer and advised me to close this myself and have him follow-up in the clinic. This is not an acceptable outcome."
The JMH ED Physician called Erie County Medical Center (ECMC) who immediately accepted the transfer of Patient #22 for closure and fixation of metacarpal fracture. Patient #22 was taken by ambulance to ECMC at 05:30 PM, his condition listed as critical.

Review of the Strong Transfer Center Audio Recording #1 dated 11/30/21 revealed a phone call was received from the Jones Memorial Hospital (JMH) Emergency Department (ED) Physician, who requested transfer of Patient #22 for a posterior left hand and distal forearm laceration with tendons showing, and the inability to extend fingers. Initially, there was significant bleeding, and a tourniquet was placed. X-rays were pending with suspect for a metacarpal fracture. The Strong Memorial Hospital (SMH) Orthopedic Hand Surgeon made a recommendation to the JMH ED Physician to "Wash it out and close the wound and set him up for referral at Strong Orthopedics." The SMH Orthopedic Hand Surgeon "reminded" the JMH ED physician of the cost the transfer and related ED charges for the patient. The JMH ED Physician again requested the transfer of Patient #22 to SMH and stated that he was uncomfortable with Patient #22's status, given the bleeding, the exposed tendons, and the probable fracture.

Review of the Strong Transfer Center Audio Recording #2 dated 11/30/21 revealed a call from Strong Transfer Center to the Jones Memorial Hospital (JMH) Emergency Department (ED). The Strong Memorial Hospital (SMH) staff requested a face sheet for Patient #22 and to speak with the JMH ED Attending Physician for an update.
The SMH staff stated, "Keep me posted on imaging results and anything else we need to discuss." The JMH ED Physician replied, "we are contacting other Trauma Centers for transfer." SMH staff replied "Okay." The call was terminated.

Interview with Staff (A), Strong Memorial Hospital (SMH) Associate Quality Officer on 06/23/22 at 02:00 PM verified the SMH medical record findings.