By Eric Wicklund
When you’re the only critical access hospital around for hundreds of miles, you’d better have the resources for treating patients in need of emergency care—or the means for quickly and effectively getting patients to the care they need.
At Rice County District Hospital in Lyons, Kansas, staff are using patient placement technology to coordinate care for both patients inside the 25-bed, level 4 hospital, and those needing to be transferred to another facility. The platform integrates local EMS and other transport services, such as helicopters and planes, with health systems hundreds of miles away who have the specialists necessary to treat a critically injured patient.
“It has been complex at times, and very stressful,” says Bonnie Goans, RN, the hospital’s trauma and emergency preparedness coordinator, who remembers instances where it has taken two weeks to get a patient to the right hospital. “The technology we have now is really helping to make things smoother and more efficient.”
With a population of about 3,500 in a county of only 9,500, Lyons sits right in the middle of Kansas and the Great Plains, an area that could be used as the dictionary definition of “rural.” There’s plenty of farmland and a few industries, including an ethanol plant. The hospital sees its fair share of farming and industrial injuries, vehicle and ATV accidents, and, like everywhere else, chronic diseases.
And it offers an ideal location to prove the value of innovative new technologies in improving healthcare access and outcomes in rural America.
Of the estimated 6,000 hospitals in the US, according to the American Hospital Association, almost 1,800, or about 30%, are in rural locations. More than 130 rural hospitals have closed over the past decade, and another 600 are at risk of closing.
Telehealth advocates have been pushing virtual technology as an avenue by which these small, remote hospitals can keep more patients in-house and improve access to services and specialists, and Goans says Rice County District Hospital has been using telehealth for a variety of services, including cardiac, pulmonary, and neurological care. But there’s only so much a 25-bed hospital with a staff of about 150 can accommodate, and some patients need care that the hospital just doesn’t have.
That’s where technology comes in—and one’s neighbors.
“That’s the good thing about being in a small community,” Goans says. “Everyone pitches in. Everyone helps when they can.”
The hospital has one EMS crew on hand and one backup, as well as access to a few helicopters and fixed-wing aircraft. There’s a level 3 trauma center 30 miles away, and a pair of level 1 hospitals in Wichita, roughly 80 miles away. But anything that takes three hours or more “is a no-go,” Goans says, because it leaves the community short of resources in case of an emergency.
The old process of arranging transports focused on the telephone, and it basically meant that anyone with hands free would place calls to (a) find the necessary transport and (b) find the right location. Now the information is pulled out of the electronic health record and fed into a platform that scans available health systems for the right clinicians and an available bed, while making sure transportation is available.
“A lot of times in the past it was your doctor making the phone calls because the nurses were busy doing something,” Goans recalls. “And there were lots of calls to make. You needed the right doctor at the right hospital, and you needed a room available, and you didn’t stop until you had the room. Then it was a race to get the patient on the road” to get to that hospital before that room was taken.
The catalyst for change was the pandemic. That, combined with a nationwide shortage of staff, created a crisis.
Suddenly every hospital was at or near capacity, and everyone was scrambling to find a bed. Hospitals across the state (and the nation) struggled not only to support and care for patients with the virus, but also to care for patients with other health concerns who had to be kept separate from infected patients, while also taking steps to shield doctors and nurses from COVID-19. One news report estimated that nearly 80 patients in Kansas alone died waiting for a hospital bed.
“We were used to being accepted” for a patient transfer, Goans says. “And suddenly that went away.”
The pandemic pushed state officials to invest in technology and resources allowing health systems to coordinate care. The state’s Department of Health and Environment and Department of Emergency Medicine signed and then extended a contract with digital health company Motient to create a network enabling more than 110 of the state’s hospitals and correctional facilities to use the company’s Mission Control platform to coordinate transfers.
“In terms of preventative healthcare and resource redeployment, the wealth of data that will come out of a statewide program like this will be invaluable in a few years,” Alana Longwell, MD, the chief medical officer at Newman Regional Hospital, a 25-bed critical access hospital in Emporia, about 160 miles from Rice County District Hospital, said in a 2021 press release announcing the contract extension. “We started using the platform to find beds, and now we use it for more than 90% of our transfer patients. The platform lets us slice and dice our data around time-critical diagnoses to help us increase efficiency and improve our transport processes.”
At Rice County District Hospital, Goans says the platform reduced the frustration level of staff almost instantly. Doctors are now able to spend more of their time with patients, while nurses handle all of the transportation details, while phone calls are only made to make sure everything is in place.
Goans says the platform allows the hospital to run more smoothly, managing inpatient resources as well as transfers, and gives administrators the data needed to stay on top of things. For a small hospital with razor-thin margins, battling a staff shortage that’s affecting the entire country, those capabilities are key to ensuring the right staff are in the right place.
“This does help us to manage care better, and in some cases, keep more of our acute care patients,” she says. “Our doctors are practicing at the top of their license now, rather than making phone calls … and we are identifying delays [and gaps] in care that can be corrected more quickly.”
The platform also facilitates telehealth and other digital health services, opening the door to more care opportunities on-site and collaborations with larger hospitals and health systems. That’s crucial for small hospitals like Rice County District Hospital that aren’t going to be expanding any time soon and need to make do with what they currently have at their disposal.
“There will always be a need to transfer patients,” Goans says. “That won’t go away.” But they can make sure those transports are quick, efficient, and necessary.
Goans expects to use more telehealth and digital health tools in the future to improve care in the hospital and surrounding community. And she has her eye on some new technology as well.
“I’m just waiting for some drones now,” she says.
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.