During current pandemic conditions, providers should not transfer medically stable patients who are appropriately isolated to the emergency room. Instead, multidisciplinary teamwork can support providing care in place.

So say Kathleen Unroe, M.D., a practicing geriatrician and researcher with the Indiana University Center for Aging Research at Regenstrief Institute, and colleagues. They published a comprehensive guideline on safe and effective hospital and emergency room transfers. 

Some other suggestions:

• Address advance care plan with every patient and family within the context of COVID-19.

• Weigh the risks and benefits of transferring residents with a febrile respiratory illness to an ER.

• Consider “forward triage” for care transitions. This involves assessing the resident’s acuity level and should involve a conversation with the receiving ER physician.

• Warm hand-offs are critical. Nursing home and ER providers need to communicate prior to a transfer and as medical decisions are being made.

“Clear communication about treatment preferences and expectations has never been more important,” Unroe said. “Especially during this pandemic, clarity on resident and family goals for care is critical.”