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For weeks, our emergency department (ED) has been "red," meaning that--theoretically, anyway--it is no longer accepting patients. Of course, sick people who come to the door are not turned away. Ambulances, however, are instructed to take patients not requiring high-level trauma services to other emergency departments in the city, and our triage staff works extra hard to redirect people who don't really need emergency care.

The other day, I walked into the main charting area of the ED and smelled pizza. This worried me, as food odors in the emergency department are, more often than not, early wafts of the aroma of vomit. A nurse must have seen my raised eyebrow: "Transfer pizza," she said.

Transfer pizza?

Apparently, our emergency department is so busy and the turnover of our inpatient beds so low that transferring a sick patient to a different hospital for admission is actually to the hospital's advantage. So when the staff of our emergency room arranges for a patient to be admitted to a hospital other than ours, the entire department gets pizza.

This seems crass to me, and I'm not sure I can completely explain why. It's certainly to a patient's advantage to be transferred in most situations--it usually results in them being on an inpatient ward far sooner than they would otherwise. I understand that hospitals need to distribute the care of inpatients to stay afloat. And yet, the presence of a reward for this perfectly legitimate coordination of resources somehow befouls it.

I suppose that transfer pizza gives makes real the widespread suspicion that we consider our bellies as much as we consider what's best for patients when coordinating care. Although this is true on a number of levels, I'd prefer a little less proof of it. Or at least, proof less greasy.