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 primarily for nurses however
leaders and unit clerks will find much of the content
relevant to support their role in patient 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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Page 1 of 39
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
How to book transportation
How to answer key billing questions for patients
How the service contract with Voyageur protects you and your
patient
Your accountabilities
How to manage complaints and who to contact when you need help
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Why are we using Non
Emergency Transport?
Ambulances need to be available in the community
for work only they can do.
CBC News: “an 87 year
old Toronto woman dies
after waiting 3 hours for
an ambulance...
Feb, 1912,
http://www.cbc.ca/news/canada/story/1912/02
/12/ambulance-delay.html
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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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The decision
algorithm
The decision algorithm guides you through three key
decisions in the order in which they need to be made.
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.
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Decision 1?
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.
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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 24 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 24 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 24 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 24 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 24 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 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?
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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.
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: Patients formed under the Mental Health Act often
require an escort. Follow the Mental Health Algorithm to
determine the need for an appropriate escort.
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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.
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: Patients formed under the Mental Health Act often
require an escort. Follow the Mental Health Algorithm to
determine the need for an appropriate escort.
.
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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 14 of 39
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 14 of 39
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. You will need to find an appropriate
Regulated Health Professional escort to support this transfer.
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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. You will need to find an appropriate Regulated Health
Professional escort to support this transfer.
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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 15 of 39
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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 15 of 39
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 15 of 39
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 15 of 39
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
You need 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 care of your 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.
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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
You need 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 care of your 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 15 of 39
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Decision 1
Case Example 8
The patient's admitting physician has written an order
"transport by ambulance". The patient does not meet
the criteria for an ambulance. You know that to honour
the order will result in a delay of transfer.
Which of the following actions should you take?
Page 16 of 39
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 patient's admitting physician has written an order
"transport by ambulance". The patient does not meet
the criteria for an ambulance. You know that to honour
the order will result in a delay of transfer.
Which of the following actions should you take?
Page 16 of 39
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 patient's admitting physician has written an order
"transport by ambulance". The patient does not meet
the criteria for an ambulance. You know that to honour
the order will result in a delay of transfer.
Which of the following actions should you take?
Page 16 of 39
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 patient's admitting physician has written an order
"transport by ambulance". The patient does not meet
the criteria for an ambulance. You know that to honour
the order will result in a delay of transfer.
Which of the following actions should you take?
Page 16 of 39
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 patient's admitting physician has written an order
"transport by ambulance". The patient does not meet
the criteria for an ambulance. You know that to honour
the order will result in a delay of transfer.
Which of the following actions should you take?
Answer:
Review the Algorithm with the physician to determine if
ambulance criteria are met is the correct choice.
Review the Algorithm with the physician and determine if the patient
meets the criteria for EMS. Let the physician know that there may be a
delay with EMS and that Voyageur is a safe option. Engage your
leader to help with additional education for the medical team when
needed.
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Decision 1
Case Example 8
The patient's admitting physician has written an order
"transport by ambulance". The patient does not meet
the criteria for an ambulance. You know that to honour
the order will result in a delay of transfer.
Which of the following actions should you take?
Answer:
Review the Algorithm with the physician to determine if
ambulance criteria are met is the correct choice.
Review the Algorithm with the physician and determine if the patient
meets the criteria for EMS. Let the physician know that there may be a
delay with EMS and that Voyageur is a safe option. Engage your
leader to help with additional education for the medical team when
needed.
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Decision 1
Case Example 9
You have a patient who needs to be transferred within
45 - 90 minutes. When you call Voyageur they inform
you that they can't get a vehicle there for 3 hours.
Yes
No
If Voyageur is unable to come in the time needed may
I call another company?
Page 17 of 39
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Decision 1
Case Example 9
You have a patient who needs to be transferred within
45 - 90 minutes. When you call Voyageur they inform
you that they can't get a vehicle there for 3 hours.
Yes
No
If Voyageur is unable to come in the time needed may
I call another company?
Page 17 of 39
Submit
Decision 1
Case Example 9
You have a patient who needs to be transferred within
45 - 90 minutes. When you call Voyageur they inform
you that they can't get a vehicle there for 3 hours.
Yes
No
If Voyageur is unable to come in the time needed may
I call another company?
Page 17 of 39
Submit
Decision 1
Case Example 9
You have a patient who needs to be transferred within
45 - 90 minutes. When you call Voyageur they inform
you that they can't get a vehicle there for 3 hours.
If Voyageur is unable to come in the time needed may
I call another company?
Answer:
NO is the correct choice
When Voyageur is not able to meet the timelines you must engage
your immediate leader. Your leader will need to investigate why
Voyageur was unable to meet the timeline.
Page 17 of 39
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Decision 1
Case Example 9
You have a patient who needs to be transferred within
45 - 90 minutes. When you call Voyageur they inform
you that they can't get a vehicle there for 3 hours.
If Voyageur is unable to come in the time needed may
I call another company?
Answer:
NO is the correct choice
When Voyageur is not able to meet the timelines you must engage
your immediate leader. Your leader will need to investigate why
Voyageur was unable to meet the timeline.
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Decision 2
Escort Selection?
Page 18 of 39
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 39
•
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
•
ADL includes: assist with transfer, assist with toileting and can empty a Foley
catheter or established Colostomy bag, open a sandwich pack, assist with
medications (can only remind and hand over for self administration)
•
Attendants also are required to practice standards for infection control, incident
reporting, lifting, privacy, and many others - for more information review the
user guide - standards appendix
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Voyageur Attendant scope of practice
Wheelchair Services
Decision 2
Escort Selection?
Page 20 of 39
Each vehicle is staffed with only a single driver.
The driver is trained in:
• Activities of Daily Living
• Gentle persuasion
• Non Violent Crisis Intervention
• The will provide door to door assistance
• They are not able to provide direct oversight as they will be driving
and unable to monitor the patient
• Attendants also are required to practice standards for infection
control, incident reporting, lifting, privacy, and many others - for
more information review the user guide - standards appendix
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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?
•
•
•
•
•
•
Page 21 of 39
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
Paramedics are not regulated health professionals
Paramedics are not certified to practice independently outside of a
certified ambulance
For more details please see the user guide located on your hospital
intranet site
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•
Your patient assessment needs to consider the care needs of the patient
during the entire time away.
•
Because your patient is off the unit and "out of sight" it is even more
important that you anticipate for the patient's comfort and care needs for
the number of hours the patient will be traveling and waiting for
treatment, diagnostics or admission.
•
If care needs are anticipated, the escort must have the knowledge and
skill to carry out all care needs as required.
•
Regardless if there is an escort or not it is the responsibility of the primary
nurse at the sending hospital to prepare for all patient care needs ( i.e.
medical & personal supplies, medications, meals and or ambulatory,
vision and hearing aids) for the anticipated duration of the transport
including wait time and return transport if applicable.
Decision 2
Does your patient
require an escort?
Page 21 of 39
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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.
For Staff
Page 23 of 39
For Leaders
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Decision 2
Case Example 1
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Yes
No
Part 1 - Do you require an escort?
Page 24 of 39
< Prev
Decision 2
Case Example 1
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Yes
No
Part 1 - Do you require an escort?
Page 24 of 39
Submit
Decision 2
Case Example 1
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Yes
No
Part 1 - Do you require an escort?
Page 24 of 39
Submit
Decision 2
Case Example 1
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Part 1 - Do you require an escort?
Answer:
YES is the correct choice
The escort must have the knowledge and judgment to manage the IV
and care interventions.
Page 24 of 39
< Prev
Next >
Decision 2
Case Example 1
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Part 1 - Do you require an escort?
Answer:
YES is the correct choice
The escort must have the knowledge and judgment to manage the IV
and care interventions.
Page 24 of 39
< Prev
Next >
Decision 2
Case Example 1a
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Yes
No
Part 2 - What if we can't find an escort, may
I call EMS?
Page 25 of 39
< Prev
Decision 2
Case Example 1a
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Yes
No
Part 2 - What if we can't find an escort, may
I call EMS?
Page 25 of 39
Submit
Decision 2
Case Example 1a
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Yes
No
Part 2 - What if we can't find an escort, may
I call EMS?
Page 25 of 39
Submit
Decision 2
Case Example 1a
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Part 2 - What if we can't find an escort, may
I call EMS?
Answer:
No is the correct choice
The patient does not meet the criteria for an ambulance and
EMS/Paramedics may not assume care for a patient that has an MRP.
Remember, the most responsible MRP for this patient are the sending
physician and the care team. You may need to work with your leader
to help find an appropriate Regulated Health Professional escort with
the knowledge and skill to care for your patient.
Page 25 of 39
< Prev
Next >
Decision 2
Case Example 1a
A patient is being transferred to a higher level
of care for admission. The patient does not
meet the criteria for an ambulance. The
patient is on continuous IV medication.
Part 2 - What if we can't find an escort, may
I call EMS?
Answer:
No is the correct choice
The patient does not meet the criteria for an ambulance and
EMS/Paramedics may not assume care for a patient that has an MRP.
Remember, the most responsible MRP for this patient are the sending
physician and the care team. You may need to work with your leader
to help find an appropriate Regulated Health Professional escort with
the knowledge and skill to care for your patient.
Page 25 of 39
< Prev
Next >
Decision 2
Case Example 2
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient has
been medicated.
Yes
No
Do you need to send an escort?
Page 26 of 39
< Prev
Decision 2
Case Example 2
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient has
been medicated.
Yes
No
Do you need to send an escort?
Page 26 of 39
Submit
Decision 2
Case Example 2
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient has
been medicated.
Yes
No
Do you need to send an escort?
Page 26 of 39
Submit
Decision 2
Case Example 2
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient has
been medicated.
Do you need to send an escort?
Answer:
YES is the correct choice
Because the patient is medicated you must provide an escort with the
judgment and knowledge to manage this patient.
You may need a second escort such as security/police if safety is a
concern.
You must send the original copy of the Form 1 when transferring the
patient.
Page 26 of 39
< Prev
Next >
Decision 2
Case Example 2
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient has
been medicated.
Do you need to send an escort?
Answer:
YES is the correct choice
Because the patient is medicated you must provide an escort with the
judgment and knowledge to manage this patient.
You may need a second escort such as security/police if safety is a
concern.
You must send the original copy of the Form 1 when transferring the
patient.
Page 26 of 39
< Prev
Next >
Decision 2
Case Example 3
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Yes
No
Part 1 - Do you need an escort?
Page 27 of 39
< Prev
Decision 2
Case Example 3
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Yes
No
Part 1 - Do you need an escort?
Page 27 of 39
Submit
Decision 2
Case Example 3
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Yes
No
Part 1 - Do you need an escort?
Page 27 of 39
Submit
Decision 2
Case Example 3
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Part 1 - Do you need an escort?
Answer:
YES is the correct choice
The patient is combative, therefore an escort is required. The MRP and
care team are ultimately responsible for this patient however because
there is no medical requirement for a Regulated Health Professional,
an alternate hospital escort with the skill and ability may be selected
e.g. security or orderly with MH experience or police if available.
Page 27 of 39
< Prev
Next >
Decision 2
Case Example 3
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Part 1 - Do you need an escort?
Answer:
YES is the correct choice
The patient is combative, therefore an escort is required. The MRP and
care team are ultimately responsible for this patient however because
there is no medical requirement for a Regulated Health Professional,
an alternate hospital escort with the skill and ability may be selected
e.g. security or orderly with MH experience or police if available.
Page 27 of 39
< Prev
Next >
Decision 2
Case Example 3a
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Part 2 - What if the patient is compliant
with family, can I send the patient in a
family vehicle instead?
Page 28 of 39
Yes
No
< Prev
Decision 2
Case Example 3a
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Part 2 - What if the patient is compliant
with family, can I send the patient in a
family vehicle instead?
Page 28 of 39
Yes
No
Submit
Decision 2
Case Example 3a
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Part 2 - What if the patient is compliant
with family, can I send the patient in a
family vehicle instead?
Page 28 of 39
Yes
No
Submit
Decision 2
Case Example 3a
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Part 2 - What if the patient is compliant
with family, can I send the patient in a
family vehicle instead?
Answer:
No is the correct choice
You are responsible for this patient. Should anything happen en route you
and your hospital could be held liable. Best Practice is to select the
appropriate vehicle and escort as per the Mental Health Decision Guide.
This patient is/has been combative and may be unpredictable. For safety
of the patient and the escort(s), a family vehicle may not be suitable due to
the patient’s unpredictability. Sending facility will need to consider escort
safety due to the patient’s unpredictability and combativeness and send an
appropriate escort (e.g. Security). Also more than one escort may be
required (e.g. Nurse and Security).
Page 28 of 39
< Prev
Next >
Decision 2
Case Example 3a
You have a patient in the ED who needs to be
transferred to another facility. The patient is
on a Form 1 and is combative. The patient is
not medicated.
Part 2 - What if the patient is compliant
with family, can I send the patient in a
family vehicle instead?
Answer:
No is the correct choice
You are responsible for this patient. Should anything happen en route you
and your hospital could be held liable. Best Practice is to select the
appropriate vehicle and escort as per the Mental Health Decision Guide.
This patient is/has been combative and may be unpredictable. For safety
of the patient and the escort(s), a family vehicle may not be suitable due to
the patient’s unpredictability. Sending facility will need to consider escort
safety due to the patient’s unpredictability and combativeness and send an
appropriate escort (e.g. Security). Also more than one escort may be
required (e.g. Nurse and Security).
Page 28 of 39
< Prev
Next >
Decision 2
Case Example 3b
You have a patient in the ED who needs to be
transferred to another facility. The patient is on a
Form 1 and is cooperative and not combative. The
patient is agreeing to the transfer and is not
medicated.
Yes
No
It Depends
Does this person need an escort?
Page 29 of 39
< Prev
Decision 2
Case Example 3b
You have a patient in the ED who needs to be
transferred to another facility. The patient is on a
Form 1 and is cooperative and not combative. The
patient is agreeing to the transfer and is not
medicated.
Yes
No
It Depends
Does this person need an escort?
Page 29 of 39
Submit
Decision 2
Case Example 3b
You have a patient in the ED who needs to be
transferred to another facility. The patient is on a
Form 1 and is cooperative and not combative. The
patient is agreeing to the transfer and is not
medicated.
Yes
No
It Depends
Does this person need an escort?
Page 29 of 39
Submit
Decision 2
Case Example 3b
You have a patient in the ED who needs to be
transferred to another facility. The patient is on a
Form 1 and is cooperative and not combative. The
patient is agreeing to the transfer and is not
medicated.
Yes
No
It Depends
Does this person need an escort?
Page 29 of 39
Submit
Decision 2
Case Example 3b
You have a patient in the ED who needs to be
transferred to another facility. The patient is on a
Form 1 and is cooperative and not combative. The
patient is agreeing to the transfer and is not
medicated.
Does this person need an escort?
Answer:
It Depends is the correct choice
This patient is on a Form 1. If the assessment of the care team determines
the patient is not at imminent harm to self or others during the entire time
away, is cooperative and agreeable to care and transfer then an escort may
not be required.
It is the decision of the sending facility, using the MH algorithm, to
determine if an escort is needed since the patient is still the responsibility
of the sending facility should anything happen during transport. If in doubt
send an escort.
Page 29 of 39
< Prev
Next >
Decision 2
Case Example 3b
You have a patient in the ED who needs to be
transferred to another facility. The patient is on a
Form 1 and is cooperative and not combative. The
patient is agreeing to the transfer and is not
medicated.
Does this person need an escort?
Answer:
It Depends is the correct choice
This patient is on a Form 1. If the assessment of the care team determines
the patient is not at imminent harm to self or others during the entire time
away, is cooperative and agreeable to care and transfer then an escort may
not be required.
It is the decision of the sending facility, using the MH algorithm, to
determine if an escort is needed since the patient is still the responsibility
of the sending facility should anything happen during transport. If in doubt
send an escort.
Page 29 of 39
< Prev
Next >
Decision 2
Case Example 3b
You have a patient in the ED who needs to be
transferred to another facility. The patient is on a
Form 1 and is cooperative and not combative. The
patient is agreeing to the transfer and is not
medicated.
Does this person need an escort?
Answer:
It Depends is the correct choice
This patient is on a Form 1. If the assessment of the care team determines
the patient is not at imminent harm to self or others during the entire time
away, is cooperative and agreeable to care and transfer then an escort may
not be required.
It is the decision of the sending facility, using the MH algorithm, to
determine if an escort is needed since the patient is still the responsibility
of the sending facility should anything happen during transport. If in doubt
send an escort.
Page 29 of 39
< Prev
Next >
Decision 2
Case Example 4
You have a patient being transported to
another facility for a CT scan. The patient is
stable and likely to return to your hospital.
The patient's IV is locked/capped for the
length of transport. The patient is 75 years of
age and history of Type 1 Diabetes. Patient
self monitors and administers own insulin.
.
Yes
No
It Depends
Do you need to send an escort?
Page 30 of 39
< Prev
Decision 2
Case Example 4
You have a patient being transported to
another facility for a CT scan. The patient is
stable and likely to return to your hospital.
The patient's IV is locked/capped for the
length of transport. The patient is 75 years of
age and history of Type 1 Diabetes. Patient
self monitors and administers own insulin.
.
Yes
No
It Depends
Do you need to send an escort?
Page 30 of 39
Submit
Decision 2
Case Example 4
You have a patient being transported to
another facility for a CT scan. The patient is
stable and likely to return to your hospital.
The patient's IV is locked/capped for the
length of transport. The patient is 75 years of
age and history of Type 1 Diabetes. Patient
self monitors and administers own insulin.
.
Yes
No
It Depends
Do you need to send an escort?
Page 30 of 39
Submit
Decision 2
Case Example 4
You have a patient being transported to
another facility for a CT scan. The patient is
stable and likely to return to your hospital.
The patient's IV is locked/capped for the
length of transport. The patient is 75 years of
age and history of Type 1 Diabetes. Patient
self monitors and administers own insulin.
.
Yes
No
It Depends
Do you need to send an escort?
Page 30 of 39
Submit
Decision 2
Case Example 4
You have a patient being transported to
another facility for a CT scan. The patient is
stable and likely to return to your hospital.
The patient's IV is locked/capped for the
length of transport. The patient is 75 years of
age and history of Type 1 Diabetes. Patient
self monitors and administers own insulin.
Do you need to send an escort?
Page 30 of 39
Answer:
NO - If the travel time plus any potential delays will not negatively
impact ongoing care and comfort then you do not need to send an
escort.
YES - If the travel time plus any potential delays could impact or delay
necessary care interventions andItorDepends
if medications administered prior
to the transfer will require monitoring then you need to send an
escort with the judgment and knowledge to provide care
interventions.
Ultimately, the primary nurse at the sending hospital is required to
use their critical thinking and professional judgment to determine the
need for an escort and to provide all essential supplies for the
duration of the trip i.e. medical and personal supplies, medications,
meals and personal aids for ambulation, hearing, or vision.
< Prev
Next >
Decision 2
Case Example 4
You have a patient being transported to
another facility for a CT scan. The patient is
stable and likely to return to your hospital.
The patient's IV is locked/capped for the
length of transport. The patient is 75 years of
age and history of Type 1 Diabetes. Patient
self monitors and administers own insulin.
Do you need to send an escort?
Page 30 of 39
Answer:
NO - If the travel time plus any potential delays will not negatively
impact ongoing care and comfort then you do not need to send an
escort.
YES - If the travel time plus any potential delays could impact or delay
necessary care interventions and or if medications administered prior
to the transfer will require monitoring then you need to send an
escort with the judgment and knowledge to provide care
interventions.
Ultimately, the primary nurse at the sending hospital is required to
use their critical thinking and professional judgment to determine the
need for an escort and to provide all essential supplies for the
duration of the trip i.e. medical and personal supplies, medications,
meals and personal aids for ambulation, hearing, or vision.
< Prev
Next >
Decision 2
Case Example 4
You have a patient being transported to
another facility for a CT scan. The patient is
stable and likely to return to your hospital.
The patient's IV is locked/capped for the
length of transport. The patient is 75 years of
age and history of Type 1 Diabetes. Patient
self monitors and administers own insulin.
Do you need to send an escort?
Do you need to send an escort?
Page 30 of 39
Answer:
NO - If the travel time plus any potential delays will not negatively
impact ongoing care and comfort then you do not need to send an
escort.
YES - If the travel time plus any potential delays could impact or delay
necessary care interventions and or if medications administered prior
to the transfer will require monitoring then you need to send an
escort with the judgment and knowledge to provide care
interventions.
Ultimately, the primary nurse at the sending hospital is required to
use their critical thinking and professional judgment to determine the
need for an escort and to provide all essential supplies for the
duration of the trip i.e. medical and personal supplies, medications,
meals and personal aids for ambulation, hearing, or vision.
< Prev
Next >
The following are guidelines - you must always use your professional judgment and
knowledge to make the decision
•
Decision 3
•
What type of NET
vehicle does the
patient need?
•
Page 31 of 39
Taxi may be used when the patient is independently ambulatory can
tolerate sitting for the duration of the travel time and is not violent.
Wheelchair vehicle may be considered if the patient is not
independently ambulatory, requires use of a wheelchair, can tolerate
sitting and requires no more than minor assistance to ambulate short
distances.
Stretcher vehicle should be used for all other NET transports, including
patients who require restraints.
< Prev
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Have the patient
ready for pick-up
Page 32 of 39
•
Your patient must be ready for pick-up when the attendants arrive.
•
Ready for pick-up: Medical Transport # (MT #) is obtained, the patient is
dressed, personal items packed, medications etc. ready, supplies ready, escort
ready, documentation is complete.
•
Documentation must go in a sealed Patient Transport Envelop. The envelope
must include all items listed on the envelope checklist.
< Prev
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Booking and Billing
Procedures
Page 33 of 39
Booking procedure
• Obtain an Medical Transport number (MT #)
• Determine the appropriate vehicle and escort using the decision guide
• Call or book on-line (where available)
• Ensure the patient is ready for pick up
• Document the transport confirmation number in the patient record
• Refer to the decision guide for more information
< Prev
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Booking and Billing
Procedures
Page 34 of 39
Billing Practice - who pays?
• Hospitals will pay for transports between hospitals within the province
of Ontario
• Patients are required to pay for transport home, to LTC, to
appointments not associated with their current admission and/or out
of province transfers
• A brochure is available to provide patients with key information about
making their own arrangements for transport when they have been
discharged and are leaving the hospital
< Prev
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The Voyageur
Contract and How
it Protects You
and Your Patient
Page 35 of 39
In 2011, after a full investigation and finding several gaps in safety, the
Ombudsman recommended the MOHLTC regulate this industry. Currently
these companies remain unregulated. To ensure our patients are safe,
hospitals in the SW LHIN co-created clinical and vehicle standards that
Voyageur must comply with under contract. The standards include but are not
limited to:
•
•
•
•
•
•
•
patient and staff safety
infection control practice
privacy
patient information security
incident management procedures
vehicle and equipment safety
attendant training - First responder and appropriate driving
certificates including defensive driving, Non violent crisis
intervention, ADL and gentle persuasion
< Prev
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•
•
Your
Responsibilities
•
•
•
To use EMS for transports as determined by the Decision Guide
To only use the NET supplier contracted by your hospital (Voyageur) they meet standards set out by a contract
To follow the decision algorithm - vehicle, escort and mode of transport
To call or book the transport on-line (where available)
To have the patient ready when the attendants arrive (and if receiving a
patient, be prompt at helping to offload)
Remember, until hand-off at the receiving facility, you and your care
team are responsible for the patient for the duration of transport.
Page 36 of 39
< Prev
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What to do if you
have complaints
or concerns?
Page 37 of 39
•
Each hospital has an on-site NET expert. This person is identified in your
online User Guide as the Hospital NET Contact (link to guide available at end
of module)
•
Your NET contact represents you and your hospital at the regional operations
committee for NET
•
If you have complaints, concerns, compliments or suggestions for
improvement, work with your immediate leader to pass on to your hospital
NET contact
< Prev
Next >
An electronic User Guide is available online on your hospital intranet site. It
provides details and guidance on a number of issues
User Guide Book
Page 38 of 39
Topics include:
• Your Role
• Ambulance Act
• Scope of Practice (NET and Attendant)
• Patient Transportation Assessment, Documentation and Escort
Decision
• Health Care Provider Accompaniment Guidelines for Patient
Transfers
• Booking and Billing Instructions
• Your hospital specific information and NET Contact Person
• NET Patient Pamphlet
• Frequently Asked Questions (FAQs)
• Definitions and Terminology
• Do Not Resuscitate Confirmation form (DNRC) Guideline. Refer
to the DNRC procedure in the User Guide
< Prev
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Where to find the
Algorithm and
Guide for Patient
Transport?
A laminated copy of the decision algorithm is available
in your unit. If you do not have adequate copies please
have your leader contact your hospital representative.
The electronic version of both the algorithm and the
user guide is on your hospital intranet.
You can view a copy here:
Algorithm
Page 39 of 39
User Guides
< Prev
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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, 2014 SW LHIN Hospitals (Version 2)
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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