Sponsored By:

The Value and Evolution of a Transfer Center Julieta Ducasa B.S.N, R.N Transfer Center Manager , BHSF

© Patient Flow Summit, 2014

Before The Transfer Center…

•  Before The Transfer Center (TTC) – Administrator on-call accepted transfers after

hours and on weekends •  Non-clinical •  Confusion and miss information •  Compliance with Emergency Medical Treatment &

Labor Act (EMTALA) •  Delay of care •  Prolonged length of stay

–  Led to higher costs

© Patient Flow Summit, 2014

So The Transfer Center was created … and it was good !

•  Operating for 5 years •  Daily average transfer 85+ •  Yearly average is 28,000 + •  Services we provide:

– Emergency Department (ED) to ED transfers •  EMTALA compliant

– Urgent Care (UC) to ED transfers –  Inpatient to Inpatient transfers – Transportation only – Emergency Preparedness

© Patient Flow Summit, 2014

23,373

26,183

28,760

28,865

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

FY10 FY11 FY12 FY13

Total Transfer Volume by Fiscal Year April 2009 - October 2013

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Transport Only 53%

UC to ED 19%

ED to ED 8%

Inpt to Inpt (Adults) 4%

Reviewed and Avoided 3%

Hand Referrals 2% ED to ED Peds

2% ED to Peds

2%

Transfers by Transfer Type FY13'

© Patient Flow Summit, 2014

“… it was good!” (continued…) •  Who do we provide services to:

– External facilities – Social Workers – Physicians – Patients & families – Emergency Departments – Urgent cares – Emergency Preparedness

•  EM Resource tool

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What about Emergency preparedness?

– Evacuation transport agreements – HavBed – Coalition

Emergency  Preparedness  Bed  Count    

Facility     Total  Licensed  beds    

ICU\CCU    Total    

Step  Down  total  

MedSurg  Total     PICU  Total     Ped  Total     NICU  Total     OR  Total     LD/  Post  

Partum  

Neg.  Pressure  Total    

MH   25   4   x   21   x   x   x   2   x   4  

HH   142   16   8   101   x   9   x   4   11\16   11  

BHM   680   32   62   430   8   48   36   21   20\55   22  

WKH   133   12   x   108   x   x   x   4   6\13   16  

SMH   456   16\12   Included  in  med  surge     275   x   x   38   10   14\56   6  

DH   281   12   6   269   x   x   x   10   X   5  

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Department     BHM   BHM  Call  Ext:   WKH   WKH  Call  Ext:   SMH   SMH  Call  Ext:   DH   DH  Call  Ext:   HH   HH  Call  Ext:   MH   MH  Call  Ext:  

Total  Licensed  Beds     680   x   133   x   456   x   281   x   142   x   25   x  

Total  Census                                                  

ICU\CCU  Capacity   32   e-­‐ICU   12   e-­‐ICU   16\12   e-­‐ICU   12   e-­‐ICU   16   e-­‐ICU   4   e-­‐ICU  

ICU\CCU  Empty       x       x       x       x       x       x  

Med.Surge\Tele  Capacity   430   68869   108   74655   275   22921   269   84118   101   37265   21   43911  

Med.Surge\Tele  Empty       x       X       x       x       x       x  

PICU  capacity   8   49558   x   x   x   X   x   X   x   x   x   x  

PICU  Empty       x   x   X   x   x   x   x   x   x   x   x  

Reg  Peds  capacity   48   49558   x   x   x   x   x   x   9   37265   x   x  

Reg.  Peds  Empty       x   x   x   x   x   x   x       x   x   x  

NICU  capacity   36   56977   x   x   49   28160   x   x   x   x   x   x  

NICU  Empty       x   x   x       x   x   x   x   x   x   x  

OR  capacity   18   66350   4   72705   10   28192   10   84118   4   37265   2   43911  

OR  Empty       x       x       x       x       x       x  

LD\Post-­‐Partum  capcaity   21\49  (+12  1EL)   49273\                      48427   6\13   72455   14\56   22701   x   x   11\16   37265   x   x  

LD\Post-­‐Partum  Empty         x       x       x   x   x       x   x   x  

Neg-­‐pressure  capcaity   22   68869   16   74655   6   22921   5   84118   11   37265   4   43911  

NegaTve  Pressure  Empty         x       x       x       x       x       x  

© Patient Flow Summit, 2014

Top 20 (Adult) accepting specialties Specialties 1% or less •  Orthopedic Surgery

•  Trauma

•  Neuro-IVR

•  General Surgery

•  Hematology – Oncology

•  IVR

•  Urology

•  Cardiothoracic Surgery

•  Vascular Surgery

•  Critical Care Medicine

•  Electrophysiology

•  Psychiatry

Emergency Medicine

49% Internal

Medicine 16%

Cardiovascular Disease

9%

Neurosurgery 5%

OB-GYN 4%

Neurology 3%

Gastroenterology 2%

Orthopedic Surgery

(General) 1%

Over 1% Accepting Specialties

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Top 10 Pediatric accepting specialties

Pediatric  Emergency  

57%

Pediatric  Critical  Care  30%

Pediatric  Orthopedics

7%

Pediatric  ENT2%

Pediatric  Nenonate

2%

Over  1%  Accepting  Specialties   Specialties 1% or less

•  Pediatric Cardiology

•  Pediatric General Surgery

•  Pediatric Neurology

•  Pediatric Hematology-Oncology

•  Pediatric Endocrinology

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Transfers out decrease

1

10

100

1,000

10,000

BHM BHC SMH DH HH MH WKBH

•  FY 11’ •  FY 12’ •  FY 13’

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What do we believe in ? •  Mission

– To be a centralized access point for our customers across the system and external facilities for all transfer requests.

– To standardize and simplify the transfer process remaining compliant with Centers for Medicare & Medicaid Services (CMS), regulations.

•  Vision: – To be the clearing center, for ALL acute patient

transfer needs.

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Transfer Center’s Evolution •  Digital to voice over IP phones

–  Voice over IP is a Web-based application –  Recorded

•  NICE •  Excel spreadsheets to Forefront •  Dial up faxing to Right-fax •  Filing to scanning charts •  Stabilization of patients prior to transfers

–  e-ICU Intensivist •  e-Cart •  24/7 availability

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Value of The Transfer Center Outcomes:

•  Capture leakage •  Employee satisfaction •  Physician satisfaction •  Decreased patient length of stay

–  Process in place –  Reduced waiting times

•  Avoid unnecessary transfers –  Educate customers –  Create awareness of services provided

•  Measure admission rate from UC transfers

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Admitted  to  BHSF38%

Discharged  home  62%

Urgent  Care  transfers  to  BHSF  EDs  October  2012  -­‐ September  2013

Data shows 38% hospital admission rate from Urgent Care transfers.

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Value (cont…)

•  Fiscal Year 2013 – 950 transfers were prevented after re-

evaluation, which avoided, just in ambulance cost, an estimated $427,500.00

– Relocated In-patients with non participating insurances to participating facilities

•  Total cases 260. –  5% increase when compared to FY 12’

© Patient Flow Summit, 2014

So what is the meaning of the word “transfer” ?

•  As per Merriam-Webster.com: – To convey form one person, place, or situation

to another. – To cause to pass from one to another – Transform, change – To move to a different place, region, or

situation.

© Patient Flow Summit, 2014

Out of the Box •  Tele-STROKE

– Using a 2ways video application

00:01:31          TSD  Centennial  ED  Tele-­‐Medicine  Cart  1  

Self  View  (On  /  Off  )  

PC  Camera  (On  /  Off  )  

Mute  (On  /  Off  )  

PC  Audio  (On  /  Off  )  

Full  Screen  (On  /  Off  )  

Share  Desktop  (On  /  Off  )  

End  Call  

Hospital

Transfer Center view

© Patient Flow Summit, 2014

© Patient Flow Summit, 2014

Where are we “transferring” to?

•  Tele-Consults – Tele Psych

•  Cruise Lines – Tele Neurosurgery

•  Sister hospitals without the service – Tele Hand specialist

•  Urgent Cares

•  Urgent Care Navigator •  Assist patients with follow up specialty care post

discharge from UC

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Closing statement

•  The full potential of the Transfer Center has yet to be discovered. We are in a time of change where technological growth and opportunities are endless. Our goal is to create an innovative approach to continue to meet the demands of our customers.

© Patient Flow Summit, 2014

Any Questions?

To access this presentation following the Summit, please visit

www.patientflowsummit.com