Get a Handle on Patient Flow at Your Hospitals

Carilion Clinic has managed its stretched hospital bed capacity with a command center and post-acute referral hub.

Carilion Clinic has mastered the intricacies of operating a command center and post-acute referral hub that manages patient transfers and efficiently transitions patients out of its hospitals for post-acute care.

Like many health systems across the country, Carilion Clinic is grappling with patient volumes that stretch bed capacity. Under these circumstances, managing patient flow and patient transfers into and out of the health system are crucial.

"We have real-time assessment of every hospital bed in the health system, including emergency departments," says Paul Haskins, MD, SVP medical director of the Carilion Transfer and Operations Center. "So when you have an enterprise command center, it has all aspects of patient flow, including a real-time situational awareness of the primary drivers of hospital systems, which include the transfer process into the system, the operating rooms, and the emergency departments."

Carilion Clinic's command center and post-acute referral hub are focused on streamlining.

"You have people and technologies, and you use them together to streamline the processes to affect patient care," Haskins says. "To have an efficient process for transfers, you must have physician-to-physician communication. In the beginning, you put the right physicians on the line, then you eliminate any sort of communication that is duplicate."

The command center manages patient transfers into and out of the health system.

"We receive transfers into our health system from several health systems," Haskins says. "We send out transfers for a few conditions such as burns, pediatric cardiology, and some transplants. It is about making the transfer process smoother—whether it is into or out of our health system."

The post-acute referral hub helps Carilion Clinic manage length of stay.

"When we look at length of stay, the patients who go to a long-term care facility or a rehab facility tend to have the longest length of stay, which makes sense based on patient needs," Haskins says.

By eliminating duplication of processes, the post-acute referral hub can streamline processes, according to Haskins.

"By having the paperwork in a repeatable and consistent environment and having relationships with different facilities, then you can streamline processes based on a mutual agreement that the facilities will take patients and trust builds up over time," he says.

Paul Haskins, MD, is SVP medical director of the Carilion Transfer and Operations Center at Carilion Clinic. Photo courtesy of Carilion Clinic.

Staffing models

To make its command center and post-acute referral hub cost effective, Carilion Clinic leadership focuses on the right mix of healthcare professionals. The post-acute referral hub poses an easier staffing challenge, with the assignment of case managers and social workers. The command center, meanwhile, has been more challenging because of the question about whether a physician needs to be on the staff.

"A big question is do you need a physician in the command center to review transfers and see whether patients can stay in their facility," Haskins says. "It is about a $1.5 million expense to have a physician in the command center at all times."

After considering the question, leadership decided to staff its command center with registered nurses who have either ICU or emergency medicine training.

"If you have a physician on the line, then that is a huge expense," Haskins says. "The nurses are experienced, so they know who needs to be on a phone call and how to streamline the process. So the right phone call goes to the right specialist or the emergency department 99% of the time."

"You can scale up and scale down [the number of nurses needed], depending on the size of your health system and how many facilities you are overseeing," Haskins adds. "We oversee seven of our own hospitals. So we have anywhere between six and seven RNs in the command center most of the time; in the middle of the night, we will go down to three."

Benefits of command centers and post-acute referral hubs

The command center concept offers health system leadership several benefits.

"We have improved transfers into our health system, [and] we have also streamlined the transfer process out of our health system when it is necessary," Haskins says. "We have also decreased length of stay compared to national benchmarks."

The post-acute referral hub has generated gains in patient satisfaction, but the biggest benefit is in improving patient flow.

"We have patients who come to our hospitals, but it is not the input that is the problem; it is the output," Haskins says. "You must do the best job that you can to streamline the discharges out of the hospital."