For a Closer Look

OFFICIAL CASE TRANSFER POLICY

Weekdays (M-F)

Day Emergency

• All cases that will DEFINITELY be going home the next day as their problem has been rapidly addressed or to their regular veterinarian for continued care.
• All toxin exposure and snake bite cases.  In some situations, if a given case is too intensive for the Day Emergency clinicians to handle given their case load, it may necessitate transferring to an internal medicine service.

Canine Internal Medicine (CIM)

• All canine cases for which an internal medicine disease has been identified as the primary problem
• Cases which may require a more extensive work-up to determine what internal medicine subspecialty may be appropriate – oncology, cardiology, etc. (i.e., a case where neoplasia may be high on the differential list, but not definitive should be transferred to CIM rather than Oncology).
• Alternate day transfer system
  • CIM will receive all dog internal medicine transfers on days 1,3,5,7,9,11,and 13 of a 2 week rotation (i.e. Mon, Wed, Fri, Sun, Tue, Thur, Sat).
  • CIM will not take any cat internal medicine case transfers.
  • Canine cases being transferred to either internal medicine service should be denoted as such in the nightly transfer email under the heading: Internal Medicine rather than Canine or Feline to avoid confusion.
  • Senior Faculty of Canine and Feline Internal Medicine may make the decision to alternate weekends during each rotation. I.E. – Canine would see all the transfers on the first weekend and Feline would see the transfers on the second. This caveat is worked out between the two faculty members on the individual rotation.

Feline Internal Medicine (FIM)

• All feline cases for which an internal medicine disease has been identified as the primary problem
• Cases which require a more extensive work-up to determine what internal medicine subspecialty may be appropriate.
• Alternate day transfer system
  • FIM will receive all dog internal medicine transfers on days 2,4,6,8,10,12, and 14 of a two week rotation (i.e. Tue, Thur, Sat, Mon, Wed, Fri, Sun,).
  • FIM will receive all feline internal medicine transfers Monday through Friday regardless.
  • Canine cases being transferred to either internal medicine service should be denoted as such in the nightly transfer email under the heading: Internal Medicine rather than Canine or Feline to avoid confusion.
  • Feline cases being transferred should be denoted as such in the nightly transfer email under the heading: Feline Internal Medicine.

Cardiology

• Cases in which cardiac disease has been identified as the primary problem.
• In most cases, the Cardiology service or back-up resident has been consulted the previous day or night and diagnostics have been performed to determine if a cardiac problem exists. 
• Cases in which respiratory disease is more likely but may still need a cardiology work-up performed to be sure should be transferred to CIM first.

Oncology

• All cases in which neoplasia has been identified as the primary problem.

Dentistry

• Rare cases in which the sole primary problem is purely dental in origin.  In most situations, the case should be transferred to a different service as the dental problem is in addition to something else and can be dealt with on a consultation basis.

Dermatology

• Rare cases in which the sole primary problem is purely dermatological.  In most situations, the case should be transferred to a different service as the dermatologic problem is in addition to something else and can be dealt with on a consultation basis.

Community Practice

• All parvovirus enteritis cases.  Occasionally a parvovirus enteritis case may be so severe that it requires highly intensive ICU care rather than regular isolation care.  In such rare instances, internal medicine would be more appropriate service to receive the transfer.  When in doubt Community practice should be the default.
• All internal medicine cases in which a work-up beyond basic blood work is NOT required, AND the patient simply needs 1-3 days of supportive care to resolve its problem.  Examples would include a case of mild gastroenteritis secondary to dietary indiscretion and a case of HGE that responded very favorably to initially fluid stabilization but needs to remain on intravenous fluids for a couple of days.
• All Good Sam cases.

Neurology

• When a neurologist is the senior clinician on service, Neurology will receive all cases in which a neurologic problem is identified as the primary problem.
• When a surgeon is the senior clinician on the Neurology service, only surgical neurologic cases should be transferred to Neurology.  Medical neurology cases should be transferred to an internal medicine service at these times.
• In rare instances when an internal medicine resident is on neurology with a surgeon as the senior clinician, the Neurology service will take both surgical and medical neurology cases.

Ophthalmology

• All cases in which the eye is involved as the primary problem.

Orthopedic Surgery

• All cases in which the primary problem will require an orthopedic surgery to resolve.
• All trauma cases in which there is bony involvement which needs to be addressed even if non-surgical (see below).

Soft-tissue Surgery

• All cases in which the primary problem will require a soft-tissue surgery to resolve.
• All cases which require wound management as the PRIMARY problem (e.g., traumas, bites, wounds, and HBCs) even if non-surgical should be transferred to Soft-tissue Surgery.  If there is any bony involvement then the case should be transferred to Orthopedic Surgery Service instead.

NOTE: There will be cases in which different problems may be appropriate for different services.  In those situations, the case should be transferred to the service that will deal with the most serious problem.  Additional problems can then either be dealt with on an inter-service consultation basis or via transferring to the next appropriate service once the first most serious problem has been addressed.

Weekends (S-S)

Internal Medicine

• The internal medicine services will take transfers on the weekends as outlined above with no distinction between weekday and weekend.  Holidays are an exception and are addressed elsewhere.

Community Practice

• Although Community Practice clinicians will not directly take case transfers over the weekend, Community Practice students will be available to be assigned to cases that would normally be transferred to Community Practice during the weekdays. In addition Community Practice students will report to the ER clinician/intern on Saturdays and Sundays at 7am to receive all other transfers that would otherwise be transferred to Day ER.  These cases will still be transferred to the Day Emergency intern as the clinician of record as has been done historically
• The Community Practice students will remain with the case through the remaining weekend.
• The case should be transferred officially to Community Practice (or appropriate service) on Monday if it is still in the hospital even if it is going home the same day.
• The morning transfer emails should reflect this.  The transfer email should list these cases under the heading: Day Emergency since the case will not actually change services but “(Community Practice student)” should be written alongside each case.  In the event of weekend changes, the Community Practice students will be available on-call. 
• Community Practice students should be utilized even if the Emergency Service student who took in the case originally will be working the following day.  This will free them up to see incoming emergencies and help prevent them from becoming overwhelmed.
• In the rare event that the in-hospital caseload for the Day Emergency students becomes overwhelming, the Community Practice students will be available by phone to be called in to help with morning treatments and diagnostics.
• A list of the on-call students with their phone numbers will be posted in Community Practice each week.

Cardiology

• The cardiology resident on back-up duty will take all cardiology transfers on the weekend with a cardiology student who will be responsible for doing the morning treatments and SOAPs.
• All cases being transferred to Cardiology MUST have had a consult with the resident prior to the morning of transfer to ensure that the case is being appropriately transferred and managed.
• In the rare instance that Cardiology faculty are scheduled as back-up instead of a resident, they will NOT be taking cardiology transfers on the weekend and they will remain with the Day emergency service.  However, the Cardiology faculty will be available for consultation.

Surgery

• All surgical cases will stay with the Emergency service until Monday unless they have surgery over the weekend.  If a case does need to have emergency surgery, it will then transfer to the on-call surgery resident and student.  The case will stay with them for the remainder of the weekend and not transfer back to the Emergency service.

All Other Services

• All other cases which do not fit the above criteria will remain with the Emergency service as has been done historically.  They will then be transferred to the appropriate service on Monday as outlined above.

Fine Print: 

• All cases that can be transferred should be transferred to the appropriate service.  Likewise, those cases that can utilize Community Practice students should utilize them.  It is not optional and should occur even if it appears that it will be a light weekend.  This ensures that a sudden influx of emergency cases will not result in poor patient care and overwhelmed emergency students even if the emergency clinicians are more than capable of handling the case load.
• All cases taken in and admitted to the hospital by the swing shift or overnight emergency doctor should be transferred the following morning.
• Day emergency doctors will keep the cases they have admitted through the weekend unless they are to be transferred to Cardiology, Medicine, or Surgery.  This means that if a case is taken in by the Day Emergency doctor on Friday and it is not eligible to be transferred, it will remain with that doctor until Monday morning.  Utilization of a Community Practice student may still apply.
• Swing shift doctors are not expected to be physically present to transfer cases in the morning.  A well written transfer sheet with a case summary should be sufficient to make sure a case transfers smoothly.  Additional questions should be held until the swing shift doctor starts his/her shift in the afternoon.