A bed opens up on a specialty unit. Can the ED “save” the bed for a patient who “might” need it?
CMS takes the position that a bed is available for accepting a transfer unless a specific named patient has been assigned to the bed but has not yet reached the bed.
The question of “saving” beds comes up under a number of circumstances:
1. We accepted a transfer patient for our last ICU bed, but now a trauma has come into our ED that will likely need the bed. Can we cancel the transfer?
2. We have several surgeries scheduled tomorrow that will need beds. Can we save the beds and turn down an emergency transfer tonight?
3. We always have several admissions after the bars close on Saturday night. Can we save beds for the anticipated demand and turn down transfer requests that would use those beds?
Applying the CMS approach to these situations, the answer is that the “saved” beds do not have a named patient admitted to them, and therefore CMS would consider them available to accept transfer patients. Turning down a patient in immediate need of the bed in favor of saving the bed for an unspecified future need would likely be cited as an EMTALA transfer violation.
In the case of the accepted transfer patient, the bed is assigned to a named patient and is therefore taken. The transfer cannot be cancelled. The subsequent local patient may have to be transferred because of lack of beds.