By Darin Vercillo, MD
Chief Medical Officer, Central Logic
Faster isn’t always better. But, in the case of a patient who urgently requires a transfer to another facility for a higher level of care, it almost certainly is. The maxims “time is myocardium” and “time is brain cells” are among other well-known sayings that describe the need for expeditious care.
Consider the example of “Mr. Brown,” a patient having chest pain who arrives at an emergency department in a small community hospital. The ED physician makes a diagnosis of ST elevation myocardial infarction (STEMI) and determines that Mr. Brown requires balloon angioplasty, a service not provided at their facility. A transfer request is submitted to a large tertiary hospital several miles away. Request received and accepted, the access center and receiving cardiologist efficiently guide the referring ED provider with pre-transfer interventions, activate the cath-lab, and secure a bed in the CCU. They are ready.
The accepting hospital is well known for its excellence with interventional cardiology cases, consistently achieving “door-to-balloon” times well inside the 90-minute industry standard for achieving an optimal outcome.
In cases like this we must also account for the time it takes to transport the patient across town from one hospital to the other. Many access centers, however, rely on inefficient processes to arrange medical transport. The access center agent makes an initial call to one or more transport providers and may have to leave a voice message. A transport dispatcher returns the call as quickly as possible, gathering information about the patient’s condition and other essential details. A third call to confirm acceptance of the transport request is potentially followed by additional calls to inform the access center that the ambulance is en route with the patient, as well as to communicate any delays and estimated time of arrival (ETA) — all details that must then be relayed to the referring and/or accepting clinicians.
All of this back-and-forth calling consumes valuable staff time, and it may lead to delays in dispatching the ambulance. In addition, both the referring and accepting locations are often in the dark about the status and ETA of the ambulance, compromising their readiness for the patient’s transfer. All the while, lurking in the back of every clinician’s mind is the keen awareness that the chances of a successful intervention fade with each passing minute. Time is myocardium.
In these scenarios many clinicians, as well as health system and hospital leaders, want to know: How can we expedite and streamline the transport of transferring patients, as part of our commitment to ensuring the best possible outcomes?
This is precisely what Central Logic addresses with its new Intelligent Transport capability. A walkthrough of a few key points helps illustrate several significant benefits for patients, providers, and healthcare organizations.
Eliminating multiple phone calls and manual workflows
Similar to other components of the Central Logic healthcare “Access and Orchestration” solution, Intelligent Transport automates and accelerates the process of coordinating patient transfers, factoring in patient acuity level, available transportation modalities, health system resources, and relationships with local transportation providers. Multiple phone calls are eliminated, as is the need for manual (error-prone) data entry.
With Intelligent Transport, the access center can alert the transport vendor about the transfer while it’s still pending, allowing the vendor to stage an ambulance closer to the referring facility. Factoring time savings and efficiencies at multiple junctures, patients can arrive at their destinations up to 75% more quickly than they would with traditional phone calls and manual workflows. The benefit of such improvement in “time to care” in cases that are especially time-dependent, such as STEMI, stroke, trauma, etc., cannot be overstated.
Reducing wait times and risks for referring providers
Referring physicians want their patients to be transferred as quickly as possible. As discussed earlier, reducing the time from decision-to-transfer to arrival allows for better clinical outcomes. Additionally, the less time a critically ill patient, such as Mr. Brown, has to wait for transport, the lower the risk exposure for the referring provider and the hospital. Lastly, a prompt discharge from the referring facility frees up space and clinicians for other incoming patients.
Enabling preparedness with real-time geo-tracking
Apart from facilitating more rapid patient transfers, Intelligent Transport offers real-time geo-tracking of vehicle status with map-based visualizations and live feeds of waypoint data (such as dispatch, patient pick up, ETA, arrival, etc.). This information benefits referring and accepting providers alike. The referring facility best understands the time frame to prep to send the patient. The accepting facility receives updates in advance of the patient arrival enabling clinicians to ready themselves and necessary resources.
All of this data creates tremendous transparency for hospitals and health systems as they select partners to provide transportation services. Most importantly though, Mr. Brown and others like him, benefit from the efficiencies gained.
Expediting transfers to post-acute care
Many patients who are discharged from a hospital require transport to a sub-acute setting, such as a skilled nursing facility. Transportation challenges exist here, too, and Intelligent Transport can make a difference. Previously, but especially in the current healthcare landscape of COVID-19, any delay in discharge to a SNF or rehab may easily result in a patient staying an extra, often non-reimbursed, night in the hospital. This also results in one less bed (or nurse) available to admit another patient. A double-penalty, such as this, is not atypical, and quickly erodes a hospital’s bottom line. With Intelligent Transport, however, the hospital quickly secures an ambulance for Mr. Brown, and he arrives at the post-acute care facility before missing the window of opportunity.
I’ve touched on a few of the ways health systems and hospitals can tap into the power of Intelligent Transport to speed the delivery of care for transferring patients, leading to improved clinical outcomes, potentially even saved lives. Clearly, Intelligent Transport offers many non-clinical benefits, too, such as more effective resource management and increased referrals from highly satisfied providers who benefit from the power of reduced time to effective patient care.
Contact Central Logic to learn more about how Intelligent Transport can augment your organization’s healthcare access and orchestration capabilities.
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