What are the guidelines for transferring a patient from one hospital to another under the Emergency Medical Treatment and Active Labor Act (EMTALA) protocol?

EMTALA Protocol for Inter-Hospital Patient Transfer

Before transferring any patient from one hospital to another, you must complete a medical screening examination, stabilize the patient within your facility's capabilities, obtain acceptance from a receiving physician who confirms available resources, and document that the medical benefits of transfer outweigh the risks. 1

Core Requirements Before Transfer

Medical Screening Examination

• Every patient must receive a medical screening examination to identify any emergency medical conditions before transfer can be considered 1
• This examination must be performed regardless of the patient's insurance status or ability to pay 2
• The screening must be sufficient to determine whether an emergency medical condition exists as defined by EMTALA 2

Patient Stabilization

• You must stabilize the patient within your facility's capabilities before transfer 1
• "To stabilize" means providing medical treatment necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely during transfer 2
• Stabilization includes securing intravenous access, airway assessment, appropriate oxygenation (maintaining peripheral oxygen saturation at 93-98% for stroke patients), and blood pressure management according to appropriate protocols 1
• Complete optimization may not be possible at the referring facility, but maximal stabilization within available resources is mandatory 3

Receiving Facility Acceptance

• The referring physician must identify and contact an admitting physician at the receiving hospital who accepts the patient in transfer 2, 1
• The receiving facility must confirm before transfer that they have available space, qualified personnel, and appropriate higher-level resources to treat the patient 1
• Hospitals with specialized capabilities have a legal responsibility to accept transfers when necessary to stabilize emergency medical conditions 2, 1

Required Documentation

Transfer Certification

• Written certification must document that the medical benefits of transfer outweigh the risks 1
• Document the specific medical necessity for transfer, including which critical resources needed for the patient's care are unavailable at your facility 1
• Complete medical records and all relevant laboratory and radiographic studies must accompany the patient (though urgent transfers should not be delayed for record assembly—these can be sent separately by fax or courier) 2

Communication Records

• Document the receiving physician's name and confirmation of acceptance 2
• Record nurse-to-nurse report given to the appropriate nursing unit at the receiving hospital 2
• Include standardized transfer forms documenting medical screening examination findings and stabilization efforts 1

Transfer Execution

Mode of Transportation

• The transferring physician determines the mode of transport (ground or air) in consultation with the receiving physician 2
• Base this decision on the urgency of the medical condition, patient stability, time savings with air transport, weather conditions, necessary medical interventions during transfer, and availability of personnel and resources 2

Transport Team and Equipment

• Experienced and trained personnel using appropriate equipment can safely transport even critically ill patients 3
• The transport team must have a command physician responsible for medical treatment during transport if a physician is not accompanying the patient 2
• Minimum required equipment includes cardiac monitor/defibrillator, pulse oximeter, blood pressure monitoring capability, oxygen supply, airway management equipment, IV fluids, and essential medications 2

Prohibited Practices (EMTALA Violations)

What Constitutes Illegal Transfer

• Transferring an unstabilized patient for non-medical reasons, particularly financial considerations such as inability to pay 2, 1
• Failing to secure acceptance from the receiving facility before initiating transfer 1
• Refusing to accept patients in transfer when your hospital has the specialized capabilities and capacity to treat them 2, 1

Penalties for Non-Compliance

• Civil monetary penalties up to $50,000 per violation 1
• Potential termination of Medicare provider agreements 1
• Liability in medical malpractice litigation 1

Common Pitfalls to Avoid

• Do not transfer patients based on insurance status or ability to pay—this is explicitly illegal and unethical 2, 1
• Do not initiate transfer before confirming the receiving facility has accepted the patient and confirmed bed availability 1
• Do not allow record preparation to delay urgent transfers—send records separately if needed 2
• Do not transfer patients to obtain services that are available at your facility but not being provided for financial reasons 2
• Do not interpret EMTALA beyond the actual statutory language, which defines "emergency medical condition" as acute symptoms of sufficient severity that absence of immediate medical attention could reasonably result in serious jeopardy to health, serious impairment to bodily functions, or serious dysfunction of any bodily organ 2

Special Considerations

On-Call Physician Responsibilities

• On-call physician services must be available within a reasonable time to provide necessary stabilizing treatment without regard to the patient's ability to pay 2
• If your hospital lacks medical staff resources to provide on-call coverage for a given specialty, you must have a plan specifying how such referrals should be managed 2
• On-call consultants must share equitably in the care of indigent patients, which may include on-site evaluation if requested 1

Patient-Requested Transfers

• Patients may request transfer after undergoing medical screening examination and stabilization within your facility's capabilities 2
• Document the patient's informed refusal and request for transfer 2