What a Three-hour Transfer Process with a Decompensating Patient Taught Me

At 7 p.m., the day hospitalist handed off 20 patients for night coverage. At about 9 p.m., a woman in her mid-40s, admitted at the end of the day shift for dizziness and facial numbness, began to decompensate, reporting worsening visual changes and headaches. About the same time, radiology reported that CT angiography demonstrated a dissecting carotid aneurysm. I concluded that she would need vascular or neurosurgery consultation, neither of which were available at our hospital. A transfer to a tertiary care facility was required, so I called the transfer center for another local health system.

What should have been a 10-minute process unfortunately turned into nearly three hours of confusion and frustration. Nobody knew which service to contact. Call sheets were outdated, so the wrong physicians were called. Some providers were unwilling to help, and it was even unclear which hospital in their network could accept this patient. The staff were unprepared to coordinate such a transfer, and the hospital network seemed to lack any sort of communication protocol for such situations.