Improve Transfer Services by First Knowing What You Don’t Know

By Matt Phillion

It’s always important to get a full picture of any situation before making key decisions. This is certainly true when it comes to patient transfer services.

According to an independent analysis, organizations outsourcing transfer services to nurse-led solution-provider Conduit Health Partners saw a 3-to-1 return on investment.

Conduit’s transfer center works to ensure that patient care is expedited to the right place for the best patient care possible. Partnering health system providers simply make one call to initiate a transfer. From there, trained nurses and transfer specialists coordinate every step by assessing hospital capability and capacity, supporting physician to physician conversation, and arranging transportation. This frees up physicians and nurses in the hospital to focus on care at the bedside.

“What we’ve found is people don’t know what they don’t know. If we’re not measuring and tracking things from a transfer perspective, leaders have no idea who they’re turning away inadvertently when other hospitals try to send them patients,” says Cheryl Dalton-Norman, president of Conduit Health Partners. “They don’t know what cases are trying to come to them and being denied due to access issues, if they don’t have the beds available or physicians aren’t readily accepting.”

Without a full view of all available data, these barriers can make it more difficult and time consuming to get a patient moved, she notes.

“These are front-end issues that, when corrected, lead to ROI and better care—by removing the barriers to bringing the appropriate patients in,” Dalton-Norman explains.

There are ways to pull patients toward your organization by targeting the capabilities your facility offer others may not, but that’s often not how hospitals really run, Dalton-Norman explains.

“We have a workforce that is tapped out, thinking, ‘We’re struggling to keep one nostril out of the water, and you want to send us more?’” she says. “But by outsourcing that process, we’re able to objectively look at the capability and capacity of our client hospitals, look at where the beds are available, staffed, and appropriately pull in those transfers other hospitals are seeking to send.”

They’re also able to look beyond just capacity and assess the specialized needs a transfer may require.

“In the ED, you’ll often have a lot of high-acuity patients coming in. We need this specialty or that specialty,” says Dalton-Norman. “We’re aware of both capacity and specialist capabilities for our systems. Yes, we could send this patient across town to a non-affiliated hospital, but they chose to come to you. Why not keep them in your system if you have the capability and the capacity at one of your other hospitals locally?”

In terms of identifying and locating specialists, Conduit stays on top of changes in providers.

“Perhaps your providers in the ED didn’t realize a new GI specialist had been brought in. They might think they need to send the patient across town when you have that expertise here. We have this bird’s eye view to look at it all holistically to maximize the availability, capacity, and capability of our clients.”

Insight is key

While for most of their client organizations, Conduit is able to see their bed boards in real time, there’s a less technical aspect to maximizing their transfer processes that comes from spending a lot of time building relationships with those organizations.

“We have deep conversations with clinical supervisors, because those are your air traffic controllers,” says Dalton-Norman. “We spend a lot of time building that relationship with the people delivering the care, so we know their capabilities in the moment.”

Conduit wants to work with organizations who are willing to commit to those regular meetings to build that deeper understanding.

“We want to update them on the patients who were not brought in, which patients weren’t accepted, where we were sending patients, which patients they had to turn away,” she says. “If you don’t know what you don’t know, it’s hard for a health system leader to make changes operationally to drive access for patients within your system.”

Every month, Conduit delves into details like how many more cardiology cases were accepted or which hospitals sent more specific types of referrals than the prior month.

“We can identify things like this other hospital just had their long-term cardiologist leave,” impacting their capacity for transfers, Dalton-Norman explains.

It can help with strategic planning for their clients, she notes.

“We might talk about how you’ve seen this many requests for pediatrics, and that leads to an organization investing in a pediatric unit because there is this kind of need outside a normal children’s hospital,” Dalton-Norman says. “We’re helping health systems think about how, for example, we’ve always offered this, but people are asking for this, so should we consider developing in that area to better meet patient needs?”

It provides data for thinking about what services you may add, for physician planning, and more. One area Conduit does significant work, for example, is in behavioral health.

“It’s unfair to patients and difficult on ED staff when a lot of behavioral health patients are boarded in the ED,” she says. “One of the things we do is expedite the patient to the right care setting, and an ED is not a therapeutic environment. You want to get behavioral health patients into a therapeutic environment, which also creates more capacity in the ED.”

There are inherently more steps to moving patients through the system for behavioral health, Dalton-Norman explains.

“We lift that responsibility from the local team and really help make sure we’re expediting the care for behavioral health patients while being respectful to both the teams and the staff,” she says.

The importance of the nurse-led concept

Conduit believes that having that first conversation being with a nurse is incredibly important, Dalton-Norman says.

“If you’re explaining a specific diagnosis, having that strong clinical background to understand the weight and expediency of what the provider is telling you is critical,” she says. “Being able to understand: This patient needs a helicopter, or they’re going to need an ICU bed. That you need these specialties who accept this type of patient. A nurse is able to think about it from various clinical angles: What is the need, what is the criticality, and how do I prioritize this?”

Their nurses are not only taking in those key details but messaging other nurses to make those necessary arrangements.

“They have a deep understanding of what’s required so you’re not fixing things on the back end,” Dalton-Norman says.

It’s also a matter of getting the right people. Because their teams are remote, they’re able to recruit nurses nationally and don’t deplete a nursing pool in one community or region, spreading out recruitment by geography and specialty.

“It’s a very different kind of nursing,” says Dalton-Norman. “You’re not pumping the patient’s chest, you’re thinking about what you need three steps down the line.”

The patient experience is fairly transparent: A better end result without feeling intrusive.

“Patients just understand they got from point A to point B in 90 minutes instead of 12 hours,” says Dalton-Norman. “It’s obviously a better patient experience if you get them to definitive care, but our transfer center is not dealing directly with the patient or family but rather with the hospitals and providers.”

It’s important, Dalton-Norman notes, that hospitals and organizations look at partnering instead of trying to handle the entire process on their own.

“I still think there’s a belief with large organizations and even some smaller ones that they can just do this for themselves. But again, if you don’t know what you don’t know, you can continue to face challenges in the transfer center space,” she says. “I think being willing to say we use our clinicians in the hands-on role and then partner with someone who lives and breathes in the transfer space every day helps all ships rise together.”

It’s an opportunity to develop new ways of doing things.

“Having a partner organization is nothing to be ashamed of,” Dalton-Norman says. “I’m proud of the work the transfer center does. It brings so much value to patients in expediting their care and lifting things from the shoulders of clinicians to allow them to be more available and present at the bedside.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.