Transcript PowerPoint – Non-Emergency Transportation

Non Emergency Transport
(NET)
What you need to know!
This ePresentation will take you approximately 25 minutes to complete
START
This training package is intended to guide physicians
through key information about patient transport that will
help you to:
a.
b.
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improve response times of EMS when
emergency transfer is needed
ensure best practice decisions are made for
the safety of your patient during transport.
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By the end of this learning session you will have met the following learning
objectives:
Learning
Objectives
You will know…
•
•
•
•
•
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Physician accountabilities for patient transport
Key decisions for patient transport between hospitals
Locating and using the decision algorithm and user guide for Patient
Transport
Scope of practice for NET attendants and EMS paramedics
Why paramedics should NOT be used as escorts
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How does this
affect you?
•
EMS is under pressure to respond to emergency calls and is having to
further withdraw from providing non-emergency hospital transfer
services
•
South West LHIN Hospitals have hired Voyageur as the NET for the
region
•
This means that health care workers must make important decisions
when patient transport is needed
•
These decisions/actions are guided by a standardized algorithm and
include but are not limited to:
•
•
•
•
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Selecting either EMS or Voyageur
Determining the appropriate escort
Choosing a vehicle; i.e. stretcher, wheelchair or taxi when
Voyageur is used
Preparing the patient for transport
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As the sending physician you are the MRP until the patient arrives, hand off is
completed and care is assumed at the receiving site regardless if the patient is
transferred with EMS or via Voyageur.
Accountabilities are:
Physician
Accountabilities
•
•
•
•
•
•
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Be familiar with the Ambulance Act
Be familiar with the scope of practice of Paramedics
Be familiar with the skills of Voyageur attendants
Be familiar with the patient transport algorithm for both medical
and mental health patients.
Ensure written orders for transport allow for decisions based on
the algorithm
Support the care team in transport decisions as required.
…continued
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•
Physician
Accountabilities
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Support the care team and /or Voyageur attendants in the event of an
anticipated death (DNRC) or unexpected death during transport. This
includes proper identification and notification of Coroner cases. For
more information see the Physician Reference Guide.
Add LINK
• Participate in disclosure and support the care team in the reporting of
adverse events that occur during transportation.
• Observe ‘patient self pay” policy requirements.
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The decision
algorithm
It is standard across the region.
It walks you through key steps for making transport and escort decisions for
your patients, both medical and mental health populations.
It gives you tips on how to obtain a quick response from EMS when your
patient needs emergency transport.
If properly followed, this guide assures you have done due diligence when
making transport decisions and arrangements.
add link to algorithm
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Decision 1?
The patient’s nurse may require your
assistance from time to time.
Click on Decision 1 box to reveal the
question for the first decision you will
have to make.
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Decision 2?
Decision 3?
Does this transfer require an
ambulance or NET (e.g.
Voyageur)?
Click on Decision 2 box to reveal
the question for the second
decision you will have to make.
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Decision
2
Decision
3
Does this transfer require an
ambulance or NET (e.g.
Voyageur)?
Click on Decision 3 box to reveal
the question for the third decision
you will have to make.
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Does this patient
require an escort?
And if so, what kind?
Decision
3
Does this transfer require an
ambulance or NET?
Does this patient require an
escort?
If so, what kind?
What type of NET vehicle does
the patient need?
Click Next to continue.
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The Ambulance Act states that -"ambulance" means a conveyance
used or intended to be used for the transportation of persons who:
Decision 1
Does this transfer require an
ambulance or NET (e.g.
Voyageur)?
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a) have suffered a trauma or an acute onset of
illness either of which could endanger their
life, limb or function or
b) have been judged by a physician or a health
care provider designated by a physician to be
in an unstable medical condition
AND
require while being transported, the care of a physician, nurse,
other health care provider, emergency medical attendant or
paramedic,
AND
require the use of a stretcher;
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First decision to be made - Does the patient meet the criteria of the
ambulance act?
Decision 1
• If Yes - the patient requires an ambulance with an appropriate
hospital escort
Does this transfer require an
ambulance or NET (e.g.
Voyageur)?
• If No, the patient may go via Non Emergency Transport (NET Voyageur) with or without an escort depending on care needs
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The following case examples have been designed to illustrate common
situations. They are not intended to cover every situation you may
come across
Decision 1
EMS or
NET (Voyageur)
Case Examples
These case examples focus on the Decision 1 (EMS or NET decision).
We recognize that escort decisions are often done simultaneously
however for learning purposes they will be managed in two separate
sections in this module.
A picture of the Decision 1 element of the algorithm has been provided
for illustration.
Before proceeding we recommend you have a copy of the algorithm to
work with.
For a full view of the algorithm click here.
Remove this box before publishing….
Edit hyperlink to where decision algorithm is available
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Decision 1
Case Example 1
A patient is needing transport to a higher level of
care, their vitals continue to be of concern and they
are at high risk of decompensating.
EMS
NET (e.g. Voyageur)
Does this patient require EMS or NET?
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Decision 1
Case Example 1
A patient is needing transport to a higher level of
care, their vitals continue to be of concern and they
are at high risk of decompensating.
EMS
NET
Does this patient require EMS or NET?
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Submit
Decision 1
Case Example 1
A patient is needing transport to a higher level of
care, their vitals continue to be of concern and they
are at high risk of decompensating.
EMS
NET
Does this patient require EMS or NET?
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Submit
Decision 1
Case Example 1
A patient is needing transport to a higher level of
care, their vitals continue to be of concern and they
are at high risk of decompensating.
Answer:
This patient needs EMS
Unstable vitals and needing a higher level of care would qualify this a
transfer by Ambulance.
This qualifies as an emergency transfer. Refer to the yellow caution
box on the algorithm.
Does this patient require EMS or NET?
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Decision 1
Case Example 1
A patient is needing transport to a higher level of
care, their vitals continue to be of concern and they
are at high risk of decompensating.
Answer:
This patient needs EMS
Unstable vitals and needing a higher level of care would qualify this a
transfer by Ambulance.
This qualifies as an emergency transfer. Refer to the yellow caution
box on the algorithm.
Does this patient require EMS or NET?
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Decision 1
Case Example 2
A patient needs to be immediately transferred
to a higher level of care for an urgent CT scan.
Vitals have been within normal range. Risk of
decompensating is low.
EMS
NET
What type of vehicle would you choose?
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Decision 1
Case Example 2
A patient needs to be immediately transferred
to a higher level of care for an urgent CT scan.
Vitals have been within normal range. Risk of
decompensating is low.
EMS
NET
What type of vehicle would you choose?
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Submit
Decision 1
Case Example 2
A patient needs to be immediately transferred
to a higher level of care for an urgent CT scan.
Vitals have been within normal range. Risk of
decompensating is low.
EMS
NET
What type of vehicle would you choose?
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Submit
Decision 1
Case Example 2
A patient needs to be immediately transferred
to a higher level of care for an urgent CT scan.
Vitals have been within normal range. Risk of
decompensating is low.
What type of vehicle would you choose?
Answer:
NET is the correct choice
The patient does not qualify for EMS as the patient is not critically
ill - life or limb is not threatened and does not need emergency
transport.
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Decision 1
Case Example 2
A patient needs to be immediately transferred
to a higher level of care for an urgent CT scan.
Vitals have been within normal range. Risk of
decompensating is low.
What type of vehicle would you choose?
Answer:
NET is the correct choice
The patient does not qualify for EMS as the patient is not critically
ill - life or limb is not threatened and does not need emergency
transport.
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Decision 1
Case Example 3
A patient is needing transfer to a higher level of care
for emergency surgery. The accepting facility is
waiting for the patient to arrive and is planning
immediate surgical intervention. The patient's vitals
are stable however the patient is at high risk of losing
life limb or function, or high risk of deteriorating.
EMS
NET (e.g. Voyageur)
What type of transport do you ask for?
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Decision 1
Case Example 3
A patient is needing transfer to a higher level of care
for emergency surgery. The accepting facility is
waiting for the patient to arrive and is planning
immediate surgical intervention. The patient's vitals
are stable however the patient is at high risk of losing
life limb or function, or high risk of deteriorating.
EMS
NET
What type of transport do you ask for?
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Submit
Decision 1
Case Example 3
A patient is needing transfer to a higher level of care
for emergency surgery. The accepting facility is
waiting for the patient to arrive and is planning
immediate surgical intervention. The patient's vitals
are stable however the patient is at high risk of losing
life limb or function, or high risk of deteriorating.
EMS
NET
What type of transport do you ask for?
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Submit
Decision 1
Case Example 3
A patient is needing transfer to a higher level of care
for emergency surgery. The accepting facility is
waiting for the patient to arrive and is planning
immediate surgical intervention. The patient's vitals
are stable however the patient is at high risk of losing
life limb or function, or high risk of deteriorating.
Answer:
EMS is the correct choice
Although the patient is stable they are at high risk and a surgical team
is waiting for them for emergency surgery.
This qualifies as an emergency transfer. Refer to the yellow caution
box on the algorithm.
What type of transport do you ask for?
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Decision 1
Case Example 3
A patient is needing transfer to a higher level of care
for emergency surgery. The accepting facility is
waiting for the patient to arrive and is planning
immediate surgical intervention. The patient's vitals
are stable however the patient is at high risk of losing
life limb or function, or high risk of deteriorating.
Answer:
EMS is the correct choice
Although the patient is stable they are at high risk and a surgical team
is waiting for them for emergency surgery.
This qualifies as an emergency transfer. Refer to the yellow caution
box on the algorithm.
What type of transport do you ask for?
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Decision 1
Case Example 4
A patient needs transfer to a higher level of care for
urgent surgery the next day. The patient's condition is
stable however they require a higher level of care
within the next 23 to 48 hrs.
EMS
NET (e.g. Voyageur)
What type of transport do you ask for?
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Decision 1
Case Example 4
A patient needs transfer to a higher level of care for
urgent surgery the next day. The patient's conditions
is stable however they require a higher level of care
within the next 23 to 48 hrs.
EMS
NET (e.g. Voyageur)
What type of transport do you ask for?
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Submit
Decision 1
Case Example 4
A patient needs transfer to a higher level of care for
urgent surgery the next day. The patient's conditions
is stable however they require a higher level of care
within the next 23 to 48 hrs.
EMS
NET (e.g. Voyageur)
What type of transport do you ask for?
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Submit
Decision 1
Case Example 4
A patient needs transfer to a higher level of care for
urgent surgery the next day. The patient's conditions
is stable however they require a higher level of care
within the next 23 to 48 hrs.
What type of transport do you ask for?
Answer:
NET is the correct choice
The patient is not critical or requiring emergency interventions.
They do NOT require EMS. However, due to their requirement for
"a higher level of care" an escort may be considered.
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Decision 1
Case Example 4
A patient needs transfer to a higher level of care for
urgent surgery the next day. The patient's conditions
is stable however they require a higher level of care
within the next 23 to 48 hrs.
What type of transport do you ask for?
Answer:
NET is the correct choice
The patient is not critical or requiring emergency interventions. They
do NOT require EMS. However, due to their requirement for "a higher
level of care" that an escort may be considered.
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Decision 1
Case Example 5
A Mental Health (MH) patient requires transport to a
higher level of care facility for MH treatment. The
patient has no medical condition - however the
patient is on a Form 1, the patient is combative and of
risk to themselves
EMS
NET (e.g. Voyageur)
Would you select EMS or NET?
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Decision 1
Case Example 5
A Mental Health (MH) patient requires transport to a
higher level of care facility for MH treatment. The
patient has no medical condition - however the
patient is on a Form 1, the patient is combative and of
risk to themselves
EMS
NET (e.g. Voyageur)
Would you select EMS or NET?
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Submit
Decision 1
Case Example 5
A Mental Health (MH) patient requires transport to a
higher level of care facility for MH treatment. The
patient has no medical condition - however the
patient is on a Form 1, the patient is combative and of
risk to themselves
EMS
NET (e.g. Voyageur)
Would you select EMS or NET?
Page 14 of 27
Submit
Decision 1
Case Example 5
A Mental Health (MH) patient requires transport to a
higher level of care facility for MH treatment. The
patient has no medical condition - however the
patient is on a Form 1, the patient is combative and of
risk to themselves
Would you select EMS or NET?
Answer:
NET is the correct choice
The patient does not have an unstable medical condition and
thus is not considered under the Ambulance Act as needing an
ambulance. NET (e.g. Voyageur) with the appropriate escort
will be able to move this patient safely and quickly.
Note: all patients formed under the Mental Health Act must
have an appropriate escort. More details available later in this
module.
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Decision 1
Case Example 5
A Mental Health (MH) patient requires transport to a
higher level of care facility for MH treatment. The
patient has no medical condition - however the
patient is on a Form 1, the patient is combative and of
risk to themselves
Would you select EMS or NET?
Answer:
NET is the correct choice
The patient does not have an unstable medical condition and
thus is not considered under the Ambulance Act as needing an
ambulance. NET (e.g. Voyageur) with the appropriate escort
will be able to move this patient safely and quickly.
Note: all patients formed under the Mental Health Act must
have an appropriate escort. More details available later in this
module.
Page 14 of 27
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Decision 1
Case Example 6
A patient requires transport to another hospital for
the next part of their care. The patient is on IV meds
that cannot be discontinued. The patient is stable.
You do not have an Regulated Health Professional
escort readily available to go with the patient.
Yes
No
Should you call EMS to take this patient?
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Decision 1
Case Example 6
A patient requires transport to another hospital for
the next part of their care. The patient is on IV meds
that cannot be discontinued. The patient is stable.
You do not have an Regulated Health Professional
escort readily available to go with the patient.
Yes
No
Should you call EMS to take this patient?
Page 15 of 27
Submit
Decision 1
Case Example 6
A patient requires transport to another hospital for
the next part of their care. The patient is on IV meds
that cannot be discontinued. The patient is stable.
You do not have an Regulated Health Professional
escort readily available to go with the patient.
Yes
No
Should you call EMS to take this patient?
Page 15 of 27
Submit
Decision 1
Case Example 6
A patient requires transport to another hospital for
the next part of their care. The patient is on IV meds
that cannot be discontinued. The patient is stable.
You do not have an Regulated Health Professional
escort readily available to go with the patient.
Should you call EMS to take this patient?
Answer:
NO is the correct choice
Ambulance criteria are unmet and Paramedics/EMS is not an
appropriate alternative when the patient does not require
emergency transport. The hospital must provide an appropriate
Regulated Health Professional escort to support this transfer.
Page 15 of 27
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Decision 1
Case Example 6
A patient requires transport to another hospital for
the next part of their care. The patient is on IV meds
that cannot be discontinued. The patient is stable.
You do not have an Regulated Health Professional
escort readily available to go with the patient.
Should you call EMS to take this patient?
Answer:
NO is the correct choice
Ambulance criteria are unmet and Paramedics/EMS is not an
appropriate alternative when the patient does not require
emergency transport. The hospital must provide an appropriate
Regulated Health Professional escort to support this transfer.
Page 15 of 27
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Decision 1
Case Example 7
A patient requires emergency transport to a higher level
of care. Vitals are unstable and patient has a high risk of
decompensating. The patient is on IV meds and is
intubated.
EMS with Regulated Health
Professional
EMS without Regulated Health
Professional
NET with Regulated Health
Professional
Would you select EMS or NET?
Page 16 of 27
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Decision 1
Case Example 7
A patient requires emergency transport to a higher level
of care. Vitals are unstable and patient has a high risk of
decompensating. The patient is on IV meds and is
intubated.
EMS with Regulated Health
Professional
EMS without Regulated Health
Professional
NET with Regulated Health
Professional
Would you select EMS or NET?
Page 16 of 27
Submit
Decision 1
Case Example 7
A patient requires emergency transport to a higher level
of care. Vitals are unstable and patient has a high risk of
decompensating. The patient is on IV meds and is
intubated.
EMS with Regulated Health
Professional
EMS without Regulated Health
Professional
NET with Regulated Health
Professional
Would you select EMS or NET?
Page 16 of 27
Submit
Decision 1
Case Example 7
A patient requires emergency transport to a higher level
of care. Vitals are unstable and patient has a high risk of
decompensating. The patient is on IV meds and is
intubated.
EMS with Regulated Health
Professional
EMS without Regulated Health
Professional
NET with Regulated Health
Professional
Would you select EMS or NET?
Page 16 of 27
Submit
Decision 1
Case Example 7
A patient requires emergency transport to a higher level
of care. Vitals are unstable and patient has a high risk of
decompensating. The patient is on IV meds and is
intubated.
Would you select EMS or NET?
Answer:
EMS with a Regulated Health Professional is the correct choice
The hospital needs to send an escort. This patient requires EMS and
your hospital is required to provide an appropriately trained
Regulated Health Professional to be responsible for the patient until
handoff at the receiving site. The paramedics will assist the escort but
all care decisions will be determined by the hospital escort and MRP.
Page 16 of 27
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Decision 1
Case Example 7
A patient requires emergency transport to a higher level
of care. Vitals are unstable and patient has a high risk of
decompensating. The patient is on IV meds and is
intubated.
Would you select EMS or NET?
Answer:
EMS with a Regulated Health Professional is the correct choice
The hospital needs to send an escort. This patient requires EMS and
your hospital is required to provide an appropriately trained
Regulated Health Professional to be responsible for the patient until
handoff at the receiving site. The paramedics will assist the escort but
all care decisions will be determined by the hospital escort and MRP.
Page 16 of 27
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Decision 1
Case Example 8
The physician has written an order “transport by
ambulance”. The patient does not meet the criteria for
an ambulance and the nurse recognizes that to honour
the order may cause a transfer delay.
Which of the following actions should the nurse
take?
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Call EMS as per order
Call Voyageur and ignore the order
Review the Algorithm with the
physician to determine if ambulance
criteria are met
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Decision 1
Case Example 8
The physician has written an order “transport by
ambulance”. The patient does not meet the criteria for
an ambulance and the nurse recognizes that to honour
the order may cause a transfer delay.
Which of the following actions should the nurse
take?
Page 17 of 27
Call EMS as per order
Call Voyageur and ignore the order
Review the Algorithm with the
physician to determine if ambulance
criteria are met
Submit
Decision 1
Case Example 8
The physician has written an order “transport by
ambulance”. The patient does not meet the criteria for
an ambulance and the nurse recognizes that to honour
the order may cause a transfer delay.
Which of the following actions should the nurse
take?
Page 17 of 27
Call EMS as per order
Call Voyageur and ignore the order
Review the Algorithm with the
physician to determine if ambulance
criteria are met
Submit
Decision 1
Case Example 8
The physician has written an order “transport by
ambulance”. The patient does not meet the criteria for
an ambulance and the nurse recognizes that to honour
the order may cause a transfer delay.
Which of the following actions should the nurse
take?
Page 17 of 27
Call EMS as per order
Call Voyageur and ignore the order
Review the Algorithm with the
physician to determine if ambulance
criteria are met
Submit
Decision 1
Case Example 8
The physician has written an order “transport by
ambulance”. The patient does not meet the criteria for
an ambulance and the nurse recognizes that to honour
the order may cause a transfer delay.
Which of the following actions should the nurse
take?
Answer:
Review the Algorithm with the physician to determine if
ambulance criteria are met is the correct choice.
EMS is withdrawing service for non-emergency transports in order to
better meet demand for emergency transports. If the patient does not
meet the criteria for an emergency ambulance transport, the transfer
will be delayed. The physician may wish to consider writing the order
to read "arrange transport as per the transport algorithm".
Page 17 of 27
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Decision 1
Case Example 8
The physician has written an order “transport by
ambulance”. The patient does not meet the criteria for
an ambulance and the nurse recognizes that to honour
the order may cause a transfer delay.
Which of the following actions should the nurse
take?
Answer:
Review the Algorithm with the physician to determine if
ambulance criteria are met is the correct choice.
EMS is withdrawing service for non-emergency transports in order to
better meet demand for emergency transports. If the patient does not
meet the criteria for an emergency ambulance transport, the transfer
will be delayed. The physician may wish to consider writing the order
to read "arrange transport as per the transport algorithm".
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Decision 2
Escort Selection?
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Before learning about Decision 2 -Escort selection, it is important that you
first understand Voyageur training (stretcher/wheelchair attendant) and
the scope of practice for Paramedics.
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Voyageur Attendant scope of practice
Stretcher Services
Decision 2
Escort Selection?
Page 19 of 27
•
Stretcher vehicles are staffed with two attendants
•
Attendants are trained in First Responder (can provide CPR, basic airway
management, O2 maintenance, and vital sign monitoring)
•
Attendants are also trained in Non Violent Crisis Intervention, Activities of Daily
Living (ADL) and gentle persuasion
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EMS Paramedics are not to be used as escorts for patients who have been
admitted to hospital or to an ED.
Here's why:
Decision 2
Escort Selection?
•
•
•
•
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The MRP for a patient admitted to hospital is the hospital physician
and the care team
Paramedics may not assume care for a patient admitted to a
hospital or an emergency department
Paramedics receive their directions from a Regional Base Hospital
physician and are not able to accept or carry out orders from a non
Base Hospital physician unless that physician assumes full care
and accompanies the patient.
For more details please see the user guide located on your hospital
intranet site.
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Decision 2
•
Your patient assessment needs to consider the care needs of the patient
during the entire time away.
•
If care needs are anticipated, the escort must have the knowledge and
skill to carry out all care needs as required.
Does your patient
require an escort?
Page 21 of 27
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Decision 2
Escort Selection
Case examples
The following case examples have been designed to illustrate some situations.
The are not intended to cover every situation you may come across.
For a better understanding of escort decisions please reference the User Guide
section - Patient Transportation Assessment, Documentation and Escorts.
Link to guide needs to go here
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Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Write an order ‘arrange for transport as per decision
algorithm’
Follow CMPC guidelines for transfers or referral
Ensure the RHP escort is supported with
appropriate orders and direction during the
transport and any anticipated time away until hand
off
Be available to support the RHP or voyageur
attendant during the transport for adverse event
should one occur during transport
All of the above
Page 23 of 27
< Prev
Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Write an order ‘arrange for transport as per decision
algorithm’
Follow CMPC guidelines for transfers or referral
Ensure the RHP escort is supported with
appropriate orders and direction during the
transport and any anticipated time away until hand
off
Be available to support the RHP or voyageur
attendant during the transport for adverse event
should one occur during transport
All of the above
Page 23 of 27
Submit
Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Write an order ‘arrange for transport as per decision
algorithm’
Follow CMPC guidelines for transfers or referral
Ensure the RHP escort is supported with
appropriate orders and direction during the
transport and any anticipated time away until hand
off
Be available to support the RHP or voyageur
attendant during the transport for adverse event
should one occur during transport
All of the above
Page 23 of 27
Submit
Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Write an order ‘arrange for transport as per decision
algorithm’
Follow CMPC guidelines for transfers or referral
Ensure the RHP escort is supported with
appropriate orders and direction during the
transport and any anticipated time away until hand
off
Be available to support the RHP or voyageur
attendant during the transport for adverse event
should one occur during transport
All of the above
Page 23 of 27
Submit
Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Write an order ‘arrange for transport as per decision
algorithm’
Follow CMPC guidelines for transfers or referral
Ensure the RHP escort is supported with
appropriate orders and direction during the
transport and any anticipated time away until hand
off
Be available to support the RHP or voyageur
attendant during the transport for adverse event
should one occur during transport
All of the above
Page 23 of 27
Submit
Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Write an order ‘arrange for transport as per decision
algorithm’
Follow CMPC guidelines for transfers or referral
Ensure the RHP escort is supported with
appropriate orders and direction during the
transport and any anticipated time away until hand
off
Be available to support the RHP or voyageur
attendant during the transport for adverse event
should one occur during transport
All of the above
Page 23 of 27
Submit
Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Page 23 of 27
Answer:
All the above is the correct choice.
As the MRP you are responsible for the patient during the entire time
the patient is away from the facility up to the time the patient is
accepted at the receiving site. This includes ensuring orders for
transport align with the transport algorithm and that care orders are
completed to support all required care during transport. Finally you or
a physician delegate must be available to the transport team ( escort,
attendant/ paramedic) should an adverse event occur during the time
away.
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Decision 2
Case Example 1
A patient is stable and transferring to another hospital.
The patient is on IV medication - The decision algorithm
supports using Voyageur with a RHP escort.
Your responsibility is to:
Page 23 of 27
Answer:
All the above is the correct choice.
As the MRP you are responsible for the patient during the entire time
the patient is away from the facility up to the time the patient is
accepted at the receiving site. This includes ensuring orders for
transport align with the transport algorithm and that care orders are
completed to support all required care during transport. Finally you or
a physician delegate must be available to the transport team ( escort,
attendant/ paramedic) should an adverse event occur during the time
away.
< Prev
Next >
Decision 2
Case Example 2
A patient is formed under the mental health act and
requires transfer to a Schedule 1 hospital. The patient is
combative.
EMS
Voyageur without an escort
Voyageur with appropriate orders for restraint
and an appropriate escort
What does the algorithm suggest is the most
appropriate transport for transferring this patient?
Page 24 of 27
< Prev
Decision 2
Case Example 2
A patient is formed under the mental health act and
requires transfer to a Schedule 1 hospital. The patient is
combative.
EMS
Voyageur without an escort
Voyageur with appropriate orders for restraint
and an appropriate escort
What does the algorithm suggest is the most
appropriate transport for transferring this patient?
Page 24 of 27
Submit
Decision 2
Case Example 2
A patient is formed under the mental health act and
requires transfer to a Schedule 1 hospital. The patient is
combative.
EMS
Voyageur without an escort
Voyageur with appropriate orders for restraint
and an appropriate escort
What does the algorithm suggest is the most
appropriate transport for transferring this patient?
Page 24 of 27
Submit
Decision 2
Case Example 2
A patient is formed under the mental health act and
requires transfer to a Schedule 1 hospital. The patient is
combative.
EMS
Voyageur without an escort
Voyageur with appropriate orders for restraint
and an appropriate escort
What does the algorithm suggest is the most
appropriate transport for transferring this patient?
Page 24 of 27
Submit
Decision 2
Case Example 2
A patient is formed under the mental health act and
requires transfer to a Schedule 1 hospital. The patient is
combative.
What does the algorithm suggest is the most
appropriate transport for transferring this patient?
Page 24 of 27
Answer:
Voyageur with appropriate orders for restraint and an appropriate
escort is the correct choice.
In this case the patient is not medically compromised and does not
meet ambulance criteria. Voyageur is appropriate and because the
patient is formed an appropriate escort must accompany the patient.
Patient and staff safety is an important consideration with a
combative/ unpredictable patient, thus the physician must ensure
appropriate restraint is ordered. Consider delaying the transfer until
all safety requirements are in place including appropriate escort
availability.
< Prev
Next >
Decision 2
Case Example 2
A patient is formed under the mental health act and
requires transfer to a Schedule 1 hospital. The patient is
combative.
What does the algorithm suggest is the most
appropriate transport for transferring this patient?
Page 24 of 27
Answer:
Voyageur with appropriate orders for restraint and an appropriate
escort is the correct choice.
In this case the patient is not medically compromised and does not
meet ambulance criteria. Voyageur is appropriate and because the
patient is formed an appropriate escort must accompany the patient.
Patient and staff safety is an important consideration with a
combative/ unpredictable patient, thus the physician must ensure
appropriate restraint is ordered. Consider delaying the transfer until
all safety requirements are in place including appropriate escort
availability.
< Prev
Next >
Writing Orders
for Transport
The recommended language for a transport order is - “
transport as per the patient transport decision algorithm”.
It is best not to limit the transport options by specifying
the mode of transport. To do so may result in delayed
transfers and /or inappropriate use of a transport type.
Ensure staff carrying out the order have all the
necessary information to assist with the decisions
required by the algorithm. This includes information
about the reasonable likelihood of the patient status
changing , the type of intervention required during
transport e.g. IV meds must continue .
Page 25 of 27
<
Prev
Next
>
On occasion patients may die during transport. In the case
where it is an anticipated death and there is a DNRC form,
the MRP will be called for direction by Voyageur as to the
disposition of the body . As MRP you are required to make
arrangements to certify the death.
Patient Death
During
Transport
In the case where the death is unexpected or the death is
anticipated but falls under the coroner act, as MRP you
are required to give instruction to transportation
attendants/paramedics and you are required to contact the
Coroner. If this is a coroner case, the vehicle will need to
stop and the scene protected until the coroner arrives.
Your responsibility is to ensure you are aware of the
guidelines as well as ensuring complete and accurate
documentation of DNR and DNRC wishes in the patients
health record.
Link
Page 26 of 27
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>
If you have any questions, please consult the Physicians User’s Guide and the
Decision Algorithm. Links are provided below. You may also consult with your
hospital unit leader.
Questions?
Add hyperlinks
& graphic then
remove this box
prior to
publishing
Algorithm
Page 27 of 27
Physicians
User Guide
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Acknowledgements
Subject Matter Experts:
Ann Toman, London Health Sciences Centre
Strategy & Project Leadership
Regional Clinical Standards Committee
ePresentation Developer
Cindy Pandke, St. Joseph's Health Care London
Organizational Development and Learning Services
Photopgraphs
Presentermedia.com
Articulate Storyline
© 2013 SW LHIN Hospitals
Reproduction and distribution of this document in whole or in part is prohibited without the
expresses permission of the publisher
c/o St. Joseph's Health Care London
518- 646-6100 x65441
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