An effective emergency transfer depends on the existence of an established procedure, which is why it is highly recommended to create a written agreement between the CSA and its designated local hospital, even if it is not required by state accreditation rules or bodies. 15 states require a hospital transfer agreement:AlabamaAlaskaArkansasConnecticutIllinoisLillinoisNevadaNew YorkNorth CarolinaOhioSouth DakotaTenessenesseeWashingtonWyoming « There may be problems with continuity of supply, » Blackmond said in a commentary. « Perhaps the revised regulations would reduce the burdens levied on CSA, but it will increase the burden on comprehensive care hospitals and not improve the quality of patient care. » Florida deals with the subject from the point of view of medical qualifications. If a physician is not allowed to perform his ASC procedures in a hospital at a reasonable distance, a transfer contract must be concluded in advance. And Georgia notes that hospitals « will not unduly reject a transfer agreement to the CSA. » 15 states require either a hospital transfer agreement or surgeons, for authorization to have privileges in a particular hospital:ColoradoFloridaGeorgiaIndianaKansasKansasMaineMarylandMissouriMissouriOklahomaOklahomaOklahomaOklahomaRhode IslandSouth CarolinaTexasUtah While 43 states require that ASCs be granted, only 30 require them to plan for the possibility of obtaining emergency outpatient care. Fifteen of them are asking for a hospital transfer contract. The others require either an agreement or a hospital that grants privileges to CSA surgeons. (See the « State Situations » sidebar.) Some states require that the hospital with which the CSA arranges transfers be within a period of CSA travel. Illinois and Mississippi, for example, indicate 15 minutes, while Oklahoma indicates 20 minutes and Florida 30 minutes. In addition, the policy should include provisions for emergency care and stabilization of CSA treatment as part of the capacity of CSA staff until the transfer of the patient. Staff need to be trained to implement this policy in the event of a medical emergency, so that regular continuing education and mock exercise sessions could be useful at a time of crisis.
The Ohio Regulation is representative of the first group and states that a CSC « must have a written transfer agreement with a hospital for the transfer of patients in case of medical complications, emergencies and other needs when they occur. » On the other hand, according to texas regulations, a CSC has « a written transfer contract with a hospital, where all CSA operated physicians have admission privileges at a local hospital. » A hospital transfer contract should look at the circumstances in which an emergency transfer should take place, identify who has the authority to make the decision to transfer a patient, and list the documents that should accompany the patient to the hospital.