Presenters: Sara Sanders, MD, and Rebecca M. Cantu, MD, MPH
Drs. Sanders and Cantu are pediatric hospitalists who played an integral role in the development of an extended transfer center for the only two free-standing pediatric hospitals in their state. They shared their experience, successes, and tips in this session.
Historically, departments at their hospitals managed transfers differently and independently of others, leading to frustration for outside providers. Call centers can act as a central access point that decreases the time outside practitioners spend on the phone trying to get connected to the correct teams and transport services. Their operations center was created to improve communication and hospital throughput without compromising patient safety. It has developed to manage not only external transfers, but also internal transfers, telemedicine and consults, beds and capacity, and disaster preparedness.
Within the operations center, the call center, bed control, and transport dispatchers are physically located near each other to optimize communications for transferring patients. The call center is staffed by two to three high-level registered nurses (RNs) and a pediatric hospitalist. The RNs take incoming transfer requests twenty-four-seven and communicate with the appropriate services as needed. For most of the calls, the RNs auto-accept patients to the emergency department (ED) and communicate information to the ED via electronic health record secure chat. This arrangement has resulted in decreased disruptions to the ED workflow and timely uploading of outside images and labs. For patients who may not warrant an ED visit, the operations center can provide same-day consults via phone or telemedicine, arrange for same-day or next-day clinic appointments, or add the hospitalist for discussion of direct admissions.
Other than accepting direct admissions, the hospitalists’ role also includes accepting admissions and signing brief admission orders from their ED, accepting transfers from other services, and providing guidance to operations center RNs or outside providers. Hospitalists are well equipped for this role as they have the most interactions with intensive care units, subspecialty services, and ED teams and have broad knowledge of the hospitalized patient and the hospital systems, including throughput and staffing capabilities. Dr. Sanders, as the operations center’s medical director, has additional protected time to perform case reviews and work with the administration and other hospital sections to develop protocols to improve workflow.
Since the operations center opened in May 2022, their hospitals have seen a significant increase in the percentage of patients admitted from the ED within 90 minutes of the admit order (from approximately 10% to over 40%) and an increase in the percentage of patients directly admitted to the floor from outside facilities (from approximately 10% to over 25%). They were also able to respond efficiently to a tornado in their city last spring by keeping constant communication with various teams and helping determine which patients could be safely moved out of the pediatric intensive care unit or ED to the floor, allowing space for any incoming trauma patients.
For the planning and development of a transfer center, the presenters recommend early involvement of all parties involved (including hospitalists), early identification of important metrics, the establishment of good electronic medical record support, and frequent networking.
- Transfer centers can be beneficial in decreasing the amount of time a referring provider spends on the phone, decreasing the number of patients going to the ED (through direct admissions, telephone or telemedicine consults, or arrangements for same-day or next-day clinic appointments), and decreasing the time it takes for a patient to get admitted to the floor from the ED.
- The call center, bed control, and transport dispatchers should be located near each other for optimal communication in the transfer process.
- Hospitalists are effective physicians to have in call centers due to their broad knowledge of hospitalized patients and hospital systems.
- When developing a transfer center, stakeholders should be involved in the beginning stages, important metrics should be determined early, good electronic medical record support should be established, and there should be regular networking both within and outside of the facility.
Dr. Nguyen is a second-year pediatric hospital medicine fellow at the University of Arkansas for Medical Sciences/Arkansas Children’s Hospital in Little Rock, Ark.