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Abstract

Introduction: Emergency medicine residents and critical care fellows have only limited instruction on the challenges surrounding inter-facility patient transfers, which includes legal considerations (such as EMTALA), knowledge of particularities of the local EMS systems (equipment, provider qualification, protocols) and adequate communication with prehospital providers and the involved physicians at the receiving facility. Methods: Emergency medicine residents and critical care fellows (in Surgery, Internal Medicine, Anesthesiology and Pediatric critical care programs) at a tertiary care academic medical center participated in a hour lecture/interactive instruction on the medical and legal aspects of inter-facility patient transfers. This was followed by a discussion of case-based scenarios. Prior to the educational intervention, participants filled out a survey that tested their knowledge in these areas, including the legal background for patient transfers, liability associated with transfer, qualification of prehospital personnel, as well as equipment and standing orders used when transporting critically ill patients. Two to three weeks later, all participants filled out a follow up survey. Using case scenarios, these critical areas were tested and the participants provided information on how the educational session had affected their experiences and confidence regarding patient transfers in their daily work life. Results: Participants had generally poor knowledge of the legal aspects of inter-facility patient transfers, though emergency medicine residents were more knowledgeable of EMTALA-related regulations than critical care fellows. Both groups also had limited understanding of the clinical and legal scope of practice of prehospital providers involved in patient transports. Participants rated their knowledge as poor to average on the pre-test. On follow up, participants were noted to have a significantly improved knowledge base, with respect to both the medical and the legal aspects of inter-facility pateitnt transfers. They felt more comfortable in accepting and facilitating patient transfers and felt that the educational intervention had affected their practice in a positive way (improved communication with transferring facilities, better ability to judge the appropriateness and feasibility of transfers). Conclusions: A one-hour educational intervention objectively increased emergency medicine residents’ and critical care fellows’ understanding of the medical and legal aspects of inter-facility patient transfers. Participants also felt much more comfortable with patient transfers in their daily practice.