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There are two specific scenarios that need to be addressed regarding consent and patient transfer. The first is ‘repatriation’, the transfer of a patient from a larger regional hospital back to the referral hospital from which the patient originated. The second issue is transfer in a surge context to maintain adequate ICU bed space in the system. We will address both scenarios here.
In a system that must be as efficient as possible, ‘repatriation’ has become a target for access and flow strategies. When patients in local hospitals require specialized care, they are sent to the regional centre where they can access expert care. However, these tertiary and quaternary sites are under many pressures to keep moving patients through the system – so as soon as the patient is stabilized to the point of no longer requiring specialized care, they need to be transferred back to their local hospital. While local hospitals are also under pressures and may be reluctant to accept such patients back, it may also be the case that family members provide a barrier. Family may believe that care provided in larger academic health care facilities is ‘better’ and therefore resist repatriation. It is important for both families and hospital staff to recognize that ‘repatriation’ is simply a form of transfer and under the provisions of the health care consent act does NOT require consent.
One of the pillars of the Critical Care Strategy (Critical Care Services Ontario) mandate is Surge Planning and Capacity Management. Under this pillar, CCSO has required all critical care facilities in the province to have surge plans in place. Each ICU must be able to accommodate a ‘minor surge’ defined as being up to 115% capacity for a short period of time. A ‘moderate surge’ is called when a minor surge is prolonged to the point of compromising scarce resource. Moderate surges allow for the transfer of patients between critical care units to make space for future patients. This transfer of patients from one overcapacity ICU to another regional ICU is clearly not done in the interests of the patient being transferred. In fact, it is likely that family would object to such a move. However, it is clear that such a transfer does NOT require consent under the provisions of the Health Care Consent Act. Admission to hospitals is a specific exclusion to the list of items that constitute treatment, and therefore require consent.