Transfer Centers Spell Relief for Rural Docs

It may sound like a bus or train depot, but for America's beleaguered emergency departments, the "transfer center" is becoming more popular as potential relief to physicians and health facilities. And it's a just-in-time concept, since finding an Rx for overcrowded EDs is one of the top hospital issues for the upcoming year.

In many cases, physicians in rural areas are using transfer facilities to ensure adequate care for patients who may have otherwise gone to an ED at a hospital that may not have, for instance, adequate ED, neuro, cardio, or orthopedic services to treat severe cuts or head injuries. 

So instead of waiting for a long time and clogging up the EDs, patients are diverted to other facilities and where they can readily be treated.

Transfer centers—which are seen as a time- and resource- saver for EDs—may make a dent in patient waiting times, too. The centers channel patients from primary care offices, or clinics and community hospitals, to acute-care settings. In some cases, by calling their physicians, patients bypass the ED altogether and are sent for specialized care by contacting the transfer centers.

Throughout the country, among the greatest challenges in the ED is improving patient flow, as reflected in a HealthLeaders Media Intelligence Report last year. Top healthcare executives said they worried about worsening ED revenue margins and increasing volumes of uninsured patients for the upcoming year.

The transfer center process reduces extraneous calls and time for ED physicians for care, says Rick Newman, director of the Mountain States Health Alliance's medical transfer center. The MSHA includes hospitals, 21 primary and preventive care centers, and numerous outpatient sites operating in 29 counties in Tennessee, Virginia, Kentucky, and North Carolina.

After the health system began a call-center and tentatively started its transfer center in the 1990s, the health system transferred about 850 patients a year. Now it transfers about 1,100 a month, with 10% of admissions impacted by the call center. ED physicians "were begging us to assist them," says Newman, a longtime engineer. "The ED physicians have an easy way to set up the transfers to move patients in and out the door to a higher level of care," he says.

"If anybody presents at the ED in any of these disease states, or in critical condition, the ED physician is going to have to transfer them to another facility," Newman says.  "At the ED, there may be a roomful of patients, and some hospitals may not be able to admit them because of their condition, and need to move them out quickly."

Newman says the transfer centers are particularly important in rural areas. In some cases, patients may have "gone to their local ED and they've been seen by a physician and essentially a determination is made they cannot meet the patients' needs," Newman says.

"In Northeast Tennessee, it's very rural, so hospitals in the network may not have orthopedic services available, or they may have no neurological surgeons," he explains. About 60% of transfers are from the ED, he says.

Under the transfer system, usually one call is made, typically to an 800 number, and within an average 30 minutes, the patient is in an ambulance or in a helicopter to another facility, Newman says. 

Nurses or physicians help coordinate the transfer center. "The impact on the ED is getting the critical care patient on the way to the other hospital in the quickest way possible," Newman says. "By doing the transfer, we're not tying up the ED physician."

At a receiving hospital, a hospitalist plays a key role in coordinating care. "It involves bringing in a specialist who may be required," he says.

Newman says the MSHA manages the patient transfers and personnel-on call schedules under its program MD Link. Newman says the hospital uses software that allows referring clinics, admitting staff, inpatient nurses, physicians and case managers to be connected.

Some hospitals still operate manually, with phone calling and written forms, and that could spell delays, Newman says.

"It used to take 20, 30, multiple calls to try different hospitals and develop relationships with physicians over the years—a lot of work for the ED physician to line up a transfer. Now they call one number," Newman says. "Before all the transfers went from ED to ED, now we have accepting physicians who don't tie up the ED," he adds.

And that, he says, is a step toward easing the bottlenecks at the ED.