Frustration with OSH transfers

Ok, ok, We're all annoyed with these. Like many of you, I'm sure, I'm at a quaternary care center. I'm finishing up my final year of med-peds, and I am crazy frustrated. I'm probably no more frustrated than you are, but I'm still frustrated, and I want to get it out in a public forum and hear your stories too. Maybe I'll even get further insight from someone who IS the outside hospital as to why some of these things happen with about 75% of all transfers. I'm also curious if anyone is at a hospital where this works better.

We get transfers from all sorts of hospitals, including our satellite hospitals (which have our EMR, so even if their notes are shitty at least I can see them and see the orders and labs.) to completely random hospitals in other states and sometimes even other countries. So to clear my head, let's just enumerate some of the things that SUCK SUCK SUCK about OSH transfers.

1. Why are they being transferred? Is it because they need liver transplant consulted (so they can be declined, inevitably . . .)? Do they need a TAVR evaluation? Are they just so sick that they're going to die no matter what and you'd rather not have it happen at your hospital so you're seeking a higher level of care? Whatever the reason, it's TOTALLY FINE. We will take the patient.

BUT.

Please just tell us why in some sort of discharge summary/hospital course document. And for the love of the patient, if you are the one accepting the transfer call, do what my amazing colleague did last week and write a clinical event note (or whatever non-billable note your institution has) telling us about the conversation you had with the transferring physician BECAUSE:

1. Figuring out anything about the patient using the outside hospital records, unless it's from one of our own centers (and even then considering the quality of some of the notes . . .) can take hours, particularly if your ED note, H&P, progress notes, consult notes, and discharge summary (but you probably didn't write one before you transferred the patient anyway) are mired in stacks of nursing evaluations about whether the patient feels safe at home, needs a ride home from the hospital, has a particular religion, and finds ponies to be appropriate stress relief during blood draws.

2. A good deal of the time, patients coming for surgical consultations are sent without imaging. I can't stand this. The surgeons (and cardiologists. And gastroenterologists. And anyone else who will be taking care of the patient clinically) need the images to evaluate the patient.

3. While I will take any patient for any reason (you know . . . because I have to.), I am frustrated when physicians and other providers promise things to the patient. Maybe they didn't promise anything. Maybe the patient just made it up when they said they were coming over to get an emergency liver transplant, cardiac catheterization THAT NIGHT or immediate consultation with the rheumatologist at midnight that their hospital doesn't have on weekends. But Imma be real honest . . . most of my patients don't know how to pronounce the word epileptologist and have never seen an EEG, so I'm betting they told them something. But (see point 2) I can't see any of it because guaranteed that conversation is not documented anywhere.

Plenty of other frustrations, but these are my current ones. I feel better already.