Patient Handoffs in Medical Travel Cases's rigid standards and approval criteria goes the extra mile to mitigate risks of complications from gaps in medical travel hand off protocols.

The primary objective of a “hand off” is to provide care continuity between providers when the patient travels out of town for surgery and returns back home to the local caregiver team for aftercare.  

When conducts pre-qualification due diligence, prior to listing a hospital or surgery center in our database, we review the hand off procedures not only in the peri-operative phase – between surgical site caregiver team members (nurses, anesthesia, surgeon, etc.) but also at the point of discharge from care as the patient is cleared as “fit to travel” back home – by air or by car or some other transportation mode.

In the mysterious world of surgery behind the masks, red lines, and swinging doors, numerous types of patient hand offs occur. These include, but are not limited to:

  • nurse shift changes
  • physicians transferring complete responsibility for a patient
  • physicians transferring on-call responsibility
  • temporary responsibility for staff leaving the surgery unit for a short time
  • anesthesiologist report to post-anesthesia care unit (PACU) recovery room nurse
  • nursing and physician hand off to inpatient units, or to different hospitals, nursing homes and home health care, and
  • critical laboratory and radiology results sent to physician offices. 

That’s all pretty standard for a patient who opts to remain in their hometown for surgery. But when medical travel is part of the scenario, the same hand off protocol often falls short of completion. 

Patient hand off involves transfer of accurate information about a patient’s care, treatment, surgery experience, and services, current condition and any recent or anticipated changes.  

According to Maria Todd of AskMariaTodd, an expert with more than 3 decades of medical tourism program development in 116 countries, simply giving a copy of medical records to the patient is insufficient and adds risks of complications. But she explains that in many countries, when a patient is ready to leave form home, all throughout the entire journey back home during international flights and traversing airport connection hubs, the patient is under no one’s service. Until the patient can get an appointment with the hometown care team, there is no one on the record as “responsible”.  In some cases, according to Ben Simons, International Director of worldwide program management for Global Protective Solutions, a travel accident and medical complications cover for medical travel / tourism brokered by Custom Assurance Placements, Ltd., medical records copies aren’t always easy to obtain. In countries outside the USA, the patient may not be entitled to a copy of medical records. 

The law of the land in the USA is that the patient owns their medical record and is always entitled to a copy. The physician owns the medium on which the record is maintained, not the information, itself. But in other countries, like Mexico, for example, the record is owned by the physician and/or hospital facility and the patient is not “entitled” to receive a copy. That must be negotiated between the parties and the physician has the prerogative to decline.  But while a copy of medical records is available in US medical travel, it simply isn’t enough to send the patient on their merry way with a copy of medical records.

When reviewers conduct due diligence, they expect to find the following protocols in place:

  1. An opportunity for the receiver of the hand off information (in both directions, upon or prior to admission and at or prior to discharge) to review relevant patient historical data, which may include previous care, treatment and services.
  2. Interactive communications allowing for the opportunity for questioning between the giver and receiver of patient information.
  3. Up-to-date information regarding the patient’s care, treatment and services, condition and any recent or anticipated changes.
  4. A process for verification of the received information, including repeat-back or read-back, as appropriate.
  5.  Interruptions during hand offs are limited to minimize the possibility that information would fail to be conveyed or would be forgotten.
  6. The cost of both hand-off consultations between surgeon and hometown care provider is accounted for and included in the bundled price for the surgery. 
We also ask to see a process map for their standardized hand off. Since every healthcare facility we allow on our database must be accredited by an accrediting body we recognize (we are extremely selective and don’t recognize all of them) usually the facilities have hand off procedures for the local care cases. But many don’t have the same protocols when patients travel in and back from out of town. The reason Todd suspects this gap arises is because many started with a cash pay surgery program for locals and it grew as people from distant places learned about the cash pay pricing and decided to travel to access care. “OFten, medical travel programs grow at a healthcare facility without thinking it through well enough.  Then there’s also the case where the patient is embarrassed to say something to the local doc because they decided to travel to access the less expensive surgical facility and save $15,000 or more and nobody knows their doctor back home is not looped in. Sometimes, they return home to the hometown doc who rejects them back and terminates the doctor-patient relationship with them. All this is avoided with proper hand off protocols and practices.” she added.

Patients and self-insured employers and other plan administrators can take comfort in knowing that if they found a surgery at a facility on, the hand off process map, check lists, physician engagement, and measurement and monitoring is in place and is evaluated periodically by the facility and also on each and every case managed by patient care coordinators if the patient or employer elects to use our care coordination and case management concierge services.
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