Safe interfacility transfers require the right information.
Should paramedics be able to request to look at an X-ray of a patient during an interfacility transfer? This is a tough position.
On one hand, the sending facility could argue they can’t pull the X-ray up because it’s on a disc, etc. They might also look at you sideways when you ask.
There are some instances though, when it may be more than appropriate to ask to see the X-ray for verification.
Important factors to consider
Imagine you are performing an interfacility transfer on a patient who just received a chest tube. Is it unheard of that the chest tube inadvertently gets placed outside of the pleural space? Not at all, it could easily happen to the best clinicians. If you are transferring a patient with a thoracostomy tube, especially for flight, it is imperative the tube is properly placed. If it is not, it could create a tension pneumothorax, and ultimately lead to death. Learning to read a basic chest X-ray can be very helpful for paramedics.
We should be able to identify proper ET tube placement, NG tube placement, fractures, pneumothoraxes, effusions, cardiomegaly and chest tube placement. Obviously, we are not radiologists, so our insight will be limited.
But being able to identify these basic things can help us in assuring a safer patient transfer by arming us with the knowledge we need.
End goal: Quality care, best outcomes
According to the American College of Emergency Physicians, the principal goal of interfacility transfer should be the optimal health and well-being of the patient. The organization also recommends that all pertinent records and copies of imaging studies accompany the patient to the receiving facility or medics electronically transfer them as soon as possible.
Guidelines established by the Emergency Nurses Association include:
- Interfacility transfers are accomplished by qualified, competent personnel using appropriate equipment and medical control.
- Transfer protocols and interfacility agreements are in place to affect a systematically acceptable, safe process.
- Maintaining patient safety and the requisite level of care throughout the interfacility transfer.
“Like field EMS, interfacility transport work needs a well-choreographed ‘dance,’” writes Mike McEvoy, PhD, NRP, RN, CCRN, the EMS coordinator for Saratoga County, N.Y., and a paramedic supervisor. “Safely moving a patient from one facility to another poses unique and different challenges to a streetwise medic. Never allow yourself to rush, and don’t ever accept a patient for transport that exceeds your skills or abilities. Plan ahead, and plan thoroughly.”
When we are asking to view X-rays, it is all in the approach. If we’re asking in a way that makes the sending facility feel we don’t trust them, they won’t be receptive.
However, if we’re professional and keeping the patient’s best interest at heart, hopefully the request will receive a positive response. We shouldn’t try to ruffle feathers. We must be able to make reasonable requests regarding the patient to whom we’re about to administer care.