Hospital transfer of the patient: what to report

One of the tensest moments in HOF practice is when the office realizes it cannot handle a situation alone. It may be a suspected vascular occlusion with a visual change, a severe allergic reaction, an acute neurological symptom or chest pain. The decision to transfer is hard enough; communication with the service that will receive the patient is usually the weak point. In minutes of tension, important information gets lost.

This page proposes an organized way to prepare the clinical summary, without replacing local protocols or the guidance of the emergency service. Emergency measures depend on training and on the institution's protocols, at the discretion of the qualified professional, according to the rules of their professional council in Brazil.

When should a transfer be considered?

The basic rule is: if there is doubt about severity and the office lacks the resources to stabilize and investigate, transfer. Some situations in which this usually happens:

• Suspected vascular occlusion with vision loss, severe eye pain, diplopia or a neurological change. The page on visual complication after filler describes the condition in detail.
• Anaphylaxis or a systemic allergic reaction. See anaphylaxis in the HOF office.
• Signs suggestive of stroke. See suspected stroke in the office.
• Chest pain or persistent syncope. See chest pain in the office and vasovagal syncope.
• Expanding hematoma with airway compression or rapid worsening (see expanding hematoma of the face).
• Severe infection or abscess with systemic signs.

When severity is clear, calling the emergency service (SAMU 192, in Brazil) comes before anything else. The clinical summary is prepared in parallel, without delaying the call.

What does the receiving service need to know?

Emergency teams work with concise, structured information. A useful way is to organize the summary in short blocks:

1. Identification: name, age, sex, a companion's contact.
2. Reason for transfer: what is happening, in one or two sentences.
3. Procedure performed: what was applied, where, when (time), by whom.
4. Timeline: time symptoms started, progression and measures taken.
5. Measures taken in the office: medications used, routes, times and response.
6. Comorbidities and allergies: prior conditions, medications in use, known allergies.
7. Vital signs: latest values and the time they were measured.
8. Product: substance name, lot, expiration date and registration, when possible.
9. Professional's contact: a direct phone number for questions.

Avoid the clinic's internal jargon and abbreviations the hospital may not know. The more neutral and objective, the more useful.

What specific information helps in each scenario?

The useful detail changes with the emergency. In general terms:

In every scenario, time is the most often lost and most critical piece of information. Record times in real time, preferably on an emergency sheet prepared in advance. See recording the emergency in the office.

What about hyaluronidase, epinephrine and others?

If rescue medications were used before the transfer, the receiving service needs to know: which one, when and with what response. Avoid writing down doses you are unsure of; record exactly what was done. Decisions about measures rest with the attending professional, based on their training and recognized protocols. For the hyaluronidase context, see hyaluronidase in the office and late vascular occlusion.

How to communicate with the patient and family?

The conversation with the patient and companion should be calm, brief and honest. Explain that there is a sign that deserves assessment in a hospital setting, what will happen next and who will follow up. Avoid minimizing ("it's probably just a scare") and avoid alarming more than necessary. After the episode, a frank conversation about what happened is part of the duty to inform. See the page on telling the patient about a suspected vascular occlusion for a language script.

Transfer summary template

Adapt the template to your clinic's protocols and your professional council's rules. Keep a copy in the patient record.

How to protect the patient's data?

Sharing information with another health service in the context of emergency care has its own legal basis under the LGPD (Brazil's data protection law), and sharing should be limited to what is necessary for care. Avoid sending photos through personal apps without control; prefer secure channels and send only what is relevant. See consent and LGPD for photos and patient record and documentation in HOF.

What to do after the transfer?

The commitment does not end when the patient enters the hospital. Stay in touch with the team and the family, record the outcome in the patient record and, where applicable, report the adverse event through official channels (see adverse event reporting: Notivisa). Review the case internally with the team, without looking for someone to blame, and adjust protocols and training.