6 Ways to Improve Patient Transfers to AMCs

Although academic medical centers have seen an 18% increase in transfers from community hospitals into their facilities over the past three years, the mortality rate for transferred patients has actually declined. That's according to data submitted from 86 university hospitals to the University HealthSystem Consortium (UHC), which represents more than 90% of the nation's nonprofit academic medical centers.

UHC attributes this improvement to better communication and partnerships between community hospitals and academic medical centers. According UHC Chief Medical Officer and SVP Mark A. Keroack, MD, MPH, advance planning is critical because decisions about transfers shouldn't be made on-the-fly.

"A lot of our member organizations have developed relationships with these community hospitals," he said in an interview. "They tend to have conversations about certain case types at a time when things are kind of cooler; when there's not a desperately ill patient right in front of you."

Keroack said community hospitals should have a transfer protocol in place long before a sick or injured person comes through the door. Here are a few steps to improve the transfer process at your organization:

1.Identify the primary referral destination: Although this may sound obvious, it may not be when there are several AMCs to choose from. Whatever the case, don't leave the choice about referral destinations to an individual's arbitrary discretion. Also remember that there "might be different destinations for different kinds of patients," Keroack said.

2.Form relationships: When transferring patients, it helps to have established professional relationship with staff at the destination, rather than picking up the phone and talking with a stranger. According to Keroack the hospital CEO and the chief medical officer, medical director, or other lead physician executive should be spearheading these relationships with AMCs. "A community hospital really ought to insist on that level of cooperation," Keroack said. "If I were running a community hospital, I'd say, 'It's my job to make sure that those conversations are happening."

3.Establish care protocols: "Even if you do know what the destination is, that doesn't necessarily mean you've had a conversation about what's the best care," Keroack said. Work with destination hospitals to develop specific care and transfer protocols for common conditions, such as stroke, sepsis, and trauma. Decide "what kinds of patients should be cared for at the university, what kinds of patients should be cared for at the community, what are reasonable treatments for these sorts of patients," Keroack said. "At least for the common case types it should be possible to have a sort of road map for how you're going to do things and at what point you're going to say: 'This is a patient who needs to travel.'"

4.Know when not to transfer: Having conversations about when to transfer may actually lead to fewer of them. If a patient has no hope of survival, she shouldn't be transferred far away from her family and familiar doctors and surroundings, Keroack said. In other cases, community hospitals may discover they're perfectly capable of dealing with certain patients themselves. "Many community hospitals are more able than they think they are to handle some of these cases, as long as they feel confident that whatever they're doing would be exactly what the destination hospital would do," Keroack said.

5.Start treatments at home: When patients have to travel long distances to an AMC, they lose valuable treatment time, Keroack said. One solution is to start treatment en-route. He points to the University of Kansas Medical Center, which was losing a lot of transfer patients to sepsis. "They were coming in pretty bad shape after traveling several hours," he said. "The folks at Kansas began a campaign to sort of coordinate the care of those patients so that once you recognize the diagnosis you would begin the first few steps of treatment out there in the field."

"Those treatments were essentially having their effect as the patient was traveling," he adds.

6.Be ready for follow-up care: "Whenever the university hospital finishes whatever it's going to do, the follow-up care needs to be at the community hospital or with some physician that's affiliated with the community hospital," Keroack said. "There needs to be good communication there and also a willingness to take the patients back."

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