Get the free STEMI Protocol Inter-Hospital Transfer Orders Set - St. Luke's

DASH* SEMI Protocol for Intercostal Transfer *Duluth Area SEMI Hospitals: (Both Essential/St. Mary's & St. Luke's) Please refer to the Minnesota SEMI Guideline for further information, or if transferring

How to fill out stemi protocol inter-hospital transfer

How to fill out stemi protocol inter-hospital transfer:

1. Ensure proper patient identification: Start by entering the patient's name, date of birth, and medical record number accurately in the designated fields of the transfer form.
2. Document the transfer reason: Indicate the specific reason for the inter-hospital transfer related to the STEMI (ST-elevation myocardial infarction) diagnosis. Provide a brief summary of the patient's condition and any pertinent medical history that led to the decision for transfer.
3. Include relevant medical information: Record the patient's vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation. Document the results of any cardiac tests performed, such as ECGs (electrocardiograms), laboratory studies, or imaging scans.
4. Specify the transferring hospital details: Fill out the information about the originating hospital, including its name, contact information, and the treating physician's name. Include any special instructions or considerations for the receiving hospital, such as pre-arranged interventional cardiac catheterization or on-call cardiologist availability.
5. Provide a transfer summary: Summarize the patient's current condition, including any symptoms or changes since admission or initial treatment. Highlight any interventions or medications administered, such as thrombolytic therapy or antiplatelet agents.
6. Include medication reconciliation: List all medications the patient is currently receiving, including their name, dose, frequency, and route of administration. Document any recent changes in medication regimens or adjustments made during treatment.
7. Ensure proper consent and pre-transport preparation: Verify if the appropriate consent forms have been signed by the patient or their legal representative for the inter-hospital transfer. Make sure the patient is stable for transport and adequately prepared, including securing intravenous lines, providing necessary equipment and supplies, and arranging for a trained healthcare professional to accompany the patient during transfer if required.
8. Communicate with the receiving hospital: Document the contact information for the receiving hospital, including their name and contact person. Provide a brief description of the transfer plan and any important clinical information that needs to be conveyed to the healthcare team at the receiving facility.
9. Obtain necessary signatures and authorizations: Ensure all required signatures are obtained, including those of the transferring physician, patient or representative, and any witnesses as per institutional policy. Update the transfer form with the date and time of completion.
10. Retain a copy for the patient's medical records: Make a copy of the filled-out stemi protocol inter-hospital transfer form to be filed in the patient's medical records at both the transferring and receiving hospitals for documentation and reference purposes.

Who needs stemi protocol inter-hospital transfer:

1. Patients diagnosed with ST-elevation myocardial infarction (STEMI) who require specialized cardiac interventions not available in the originating hospital.
2. Patients with significant myocardial ischemia or ongoing chest pain, suggestive of acute coronary syndrome, who may benefit from urgent catheter-based revascularization.
3. Individuals who exhibit signs of cardiogenic shock or hemodynamic instability secondary to a STEMI, requiring immediate transfer to a higher-level care facility equipped to manage such complications effectively.

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