Redesigning the transfer center process to adapt to increasing demands for services.

Abstract

156 Background: Hospitals are faced with limited resources and a need to provide care to patients with the greatest needs. Methods: Develop a systematic approach for accepting external transfers to the appropriate setting of care based on clinical criteria Initiate communication between external physicians and accepting MDA (MD Anderson) physicians and ICU physicians as appropriate Identify a process for documenting clinical information to ensure appropriate and timely transfers to MDA Ensure policies and procedures align with EMTALA regulation. Results: MDA ICU physicians involved in the initial decision, as appropriate External transfer acceptance based on bed availability MDA physician must be physically present to manage transfer, conduct evaluation and develop treatment plan Incorporate into procedure telephone communication with external physician, TC Medical Director, MDA accepting physician (ICU and Pedi physician as appropriate) Operational definitions for routine and urgent have been established Non-emergent transfers occur weekdays between the hours of 8AM and 5PM Transfer Acceptance Form to capture clinical information was developed. Conclusions: Problem 1: Suboptimal Communication Developed a TC form. During first eight months of operation we achieved 85% compliance with regards to documentation of transfer. Compliance continues to trend upward. Problem 2: Placement of Patients in Appropriate Care Settings Decreased utilization of MDA Emergency Center beds noted as external transfer to inpatient beds increased. Problem 3: Sporadic Arrival of Non-emergent Transfers The majority of after-hours (between 5PM and 8AM) transfers were routine and urgent prior to project. After the intervention, the number of routine and urgent after-hours transfer trended downwards. After-hour emergent transfers increased indicating appropriate utilization of beds for patients with the greatest needs. Problem 4: Lack of Systematic Screening and Documentation Retrospective medical record audits of 100% of emergent transfers were conducted by the TCMedical Directors in collaboration with the Director of Patient Resources. 97% of emergent transfers were confirmed as emergent on retrospective review.