Richard Watson, M.D.

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Interfacility patient movement is complicated in real-time, as many factors impede a standardization. Patients are often present with time-critical diagnoses and hospital’s staff must have institutional knowledge of which receiving facilities can best meet their needs. During the decision-making process, clinicians at multiple facilities quickly concur on the best course of treatment, given the constraints in place. Clear communication must continue after the patient is moved to 

Improving interfacility patient movement is an art and a science: to be well-executed, it requires clinical judgment and aggregated data. An interfacility transfer decision should be based on the patient’s clinical situation, current needs, available resources,and desired outcomes. By establishing a strong patient movement infrastructure and standardized processes to quantify these variables, the system can flex to meet each patient’s needs.

Common Problems Caused by Inadequate Infrastructure

When healthcare systems cannot balance care quality decisions against the convenience of compartmentalized functions, the human determinants of care are often ignored. Consider patients who have suffered an acute stroke. While it may be easier for a rural hospital to automatically transfer stroke patients to a large care center far away, a regional stroke center 

. When patients are admitted in closer proximity to their homes, family members can better support their care journey. Yet if the local hospital does not proactively pre-determine the patient’s return for rehabilitation services, the patient will likely complete rehab at the large referral center.

Without an adequate infrastructure for patient movement, health systems tend to accrue unnecessary expense—and cost patients chances at better outcomes. Patients are often transferred to a receiving facility only for clinicians to belatedly discover that the patient has needs they cannot meet. The patient is then transferred a second time, or even a third time, to more appropriate destinations. On a national scale, our disjointed approach to patient movement means we have no cumulative data on the number of these unfortunately common ‘skip transfers,’ .

The Critical Importance of Process Planning

Faced with high diversion rates or poor emergency services wait times, many healthcare systems simply throw money at the problem—without establishing an infrastructure to facilitate better care coordination. They might set aside funds for a new transfer center, purchase ambulances, or hire more emergency personnel without ensuring that they have the processes to make these new resources effective.

Many healthcare systems use few data points to establish best-practice guidelines for various patient circumstances. As a result, staff have little insight into responding to resource constraints, identifying an appropriate accepting facility, and communicating a provisional diagnosis and acuity assessment. Without open communication between the referring and accepting facility, patients can suffer from poor 

For interfacility transfers to function seamlessly, with as little harm to care quality as possible, healthcare systems should ensure:

Referring facilities have consistent processes, solid connections to receiving facilities, and a centralized method of synthesizing clinical input regarding the patient’s best interests

Emergency Services (EMS) have tools with which to participate in patient care as an equal member of the care team

Receiving facilities commit to supporting outlying facilities, including urgent care centers, rural hospitals, and behavioral health clinics

As the pandemic has shown, our healthcare system is rife with disparities in care. Without a system that connects patients in crisis with the appropriate services in a timely, deliberate manner, these gaps will only widen. By establishing an overarching infrastructure for handling urgent transfers, facilities will be better equipped to make informed decisions to maintain care quality, ease overcrowding, and ensure sustainability of the healthcare ecosystem.

Dr. Richard Watson is the co-founder of Motient, a pioneer in patient movement solutions that equip hospitals, healthcare networks, and ACOs with the data required to ensure quality care and value in patient transfers.

Articles

Improving interfacility patient movement is an art and a science: to be well-executed, it requires clinical judgment and aggregated data.

Richard Watson, M.D.

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Improving Interfacility Transfers: Better Processes Impact Outcomes