Case Study: The Relationship Between Transfer Processes, Level Of Care, And Fiscal Performance

Maimonides: 10 Takeaways From A Successful Transfer Center Startup

Without effective processes, transferring patients can take hours. Process gaps can also result in inefficient operations reducing the quality of patient care while increasing hospital costs. However, when patients are quickly and efficiently transferred to the appropriate level of care, the quality of care increases, hospitals can serve more patients, and hospital fiscal performance improves.

Maimonides Medical Center understands the relationship between transfer processes, level of care, and the fiscal performance of the hospital. In September 2013, Maimonides took an important step in improving their operational efficiency by implementing a new transfer center.

The addition of the transfer center made an immediate impact on the volume of transfers coming into the hospital and on the hospital’s fiscal performance. For example, Maimonides averaged more than twice as many interhospital transfers each month during the transfer center’s first year. The positive changes have helped Maimonides stay competitive while improving the quality of patient care.

Successfully implementing a new transfer center requires more than just the installation of sophisticated software. This case study:

  • Reviews the business drivers for the new transfer center
  • Summarizes 10 takeaways from the successful implementation
  • Shares some data points that reflect the transfer center’s impact

A CULTURE OF CARING AND THE BUSINESS DRIVERS
FOR POSITIVE CHANGE

Since being founded in 1911 as a small dispensary, Maimonides has evolved into a thriving medical center. Located in Brooklyn, New York, the medical center remains a vital not-for-profit, non-sectarian hospital. Based on core principles including clinical excellence, innovation, education, and respect, Maimonides has been able to consistently provide a level of service and care that far exceeds standards.

Maimonides has always been dedicated to creating a culture of continuous innovation. Its leaders knew that a centralized contact center to facilitate referrals, appointments, and communication for physicians and patients would facilitate growth and improve the patient experience. They pinpointed the development of a transfer center as the first phase of their initiative.

A typical transfer center coordinates inbound transfers of patients from primary care providers’ offices, freestanding emergency clinics, and community hospitals into acute care settings where a higher level of care can be provided. Acting as a link between referring and accepting providers, transfer centers allow clinicians to send their patients directly to the appropriate level of care, avoiding delays in treatment.

When Maimonides decided to embark on their journey to develop a centralized transfer center, their method for transfers was inefficient. The referring physician would call the admitting physician, and their offices would coordinate the transfer, even though such requests should have been called in to Admitting by the referring physician’s office. Communication at all points of the transfer was fragmented, and the long process sometimes jeopardized patient care and/or resulted in losing the transfer to a competing facility.

Awareness of these issues made the creation of a transfer center one of the hospital’s key strategic initiatives. Leaders at Maimonides set the expectations that the transfer center would:

  • Facilitate transfers and direct admissions from physicians and hospitals
  • Improve patient and physician access to the medical center by providing a centralized entry point and telephone number
  • Increase the volume of referrals and transfers from physicians and hospitals
  • Improve communication with referring physicians upon patient arrival

When Maimonides opened its transfer center in September 2013, the spirit of these objectives had already been incorporated into the design, processes and technology, and was embraced by all of its staff. The new transfer center streamlined Maimonides’ approach to taking calls, identifying care resources, and providing patient care.

Maimonides implemented a one-call transfer center that accepts all service lines. Transfer center staff members were taught to efficiently find the right doctor, find the right bed, and arrange the transport. Registered nurses (RNs) were made available 24/7 to connect callers with specialists and to answer any questions that callers might have. The transfer center team took on responsibility for transfers not only from hospital to hospital but also from doctors’ offices to hospitals.

10 TRANSFER CENTER STARTUP TAKEAWAYS

Designing and implementing a transfer center was an excellent learning experience. Here are some key points Maimonides took away from their experience and are worth considering when implementing or improving a hospital transfer center.

1. Emphasize effective communication

Poor communication regularly caused problems before the transfer center initiative. Maimonides leadership recognized this issue and stressed the importance of improving communication between hospital departments, referring physicians, and patients as part of the project.

Barbara Sommer, Vice President of Patient Flow Services, said, “You can never communicate too much. Ongoing communication before, during, and after our transfer center implementation has been essential to our success.”

2. Obtain senior leadership support

The team driving the transfer center initiative recognized the importance of senior management buy-in early on. They worked to help all key players understand the transfer center’s value to the institution and its patients.

Maria Ferlita, Senior Vice President of Finance, said, “The success of this initiative was due to the support of senior leadership including physicians. For example, Dr. Gregory Ribakove, Chief of Cardiothoracic Surgery, was a sponsor of the project, having recognized gaps within the existing process. Additionally, from the beginning we engaged our labor force through our Labor Management Council, ensuring their buy-in. This became everyone’s initiative.”

Scott Jordan, Central Logic co-founder and chief innovation officer, added, “The leadership at Maimonides was engaged throughout the process. They came to each consultation session eager to share information and learn from our consultants. In the end, a highly efficient process was created by these collaborative efforts.”

3. Establish specialty-specific protocols and processes

Maimonides provides care for over 70 subspecialties. With such a diverse set of incoming patient needs, establishing specific protocols and processes for each specialty was vital. “Developing protocols has helped with physician buy-in. Knowing that the nursing staff will be gathering pertinent information they need to take care of the patient has increased the physicians’ trust in the transfer center team,” said Sommer.

Ferlita added, “The clinical staff’s ability to view patient information prior to the patients’ arrival and to communicate with transferring clinicians about any questions or concerns is essential to effective and safe patient care.”

More than a year after opening, the transfer center continues to review and add new protocols and processes to accommodate its diverse patient needs.

 

4. Hire the right staff

Successful transfer centers hire great people to support their efforts. Staff members must catch the vision of the role the transfer center plays in the overall success of the hospital and in the effective care of patients. Staff with both clinical and non-clinical backgrounds can contribute to a transfer center’s success. Maimonides made a strategic decision to hire registered nurses already familiar with their hospital to staff the new transfer center.

“The staff hired had varied clinical experiences in nursing, but all of the RN staff came from units in the hospital,” said Sommer.

Jordan added, “The transfer center staff at Maimonides is highly skilled and they take their jobs seriously. With their pleasant demeanor and their relentless dedication to exact documentation, the information that comes along with the transferred patient is accurate and timely.”

5. Market your transfer center

Before the transfer center ever opened, the Maimonides team began working on a marketing plan to promote the new center and its corresponding services. The team recognized that it was important for both internal staff and external healthcare providers to understand what the transfer center was and why it would be valuable to them.

When the center opened, the Maimonides team announced it by notices on the hospital’s intranet, letters to referring physicians, and institutional signage throughout the medical center—even via the screensavers on hospital computers. Senior hospital leadership educated referring physicians outside of Maimonides about the benefits of the transfer center services.

Within Maimonides, leaders worked together to promote the transfer center. Sommer shares some examples of the efforts made, “Our IT Department assisted us by placing a transfer center screensaver on all the computers throughout the Medical Center. And our ED Chairman arranged for us to meet with ED physician representatives from other EDs to discuss how we can help facilitate transfers quickly and efficiently.”

6. Select the best technology solution

Maimonides leadership recognized early on that technology would play a key role in the success of their transfer center. They carefully researched available options before selecting Central Logic Transfer Center. Functional elements such as ’s ability to send bed requests to other systems and Transfer Center’s robust reporting functionality were compelling features that helped motivate the direction of the Maimonides team.

Their technology decision was not only based on the software’s proven capabilities, though. Maimonides sought an experienced partner that could also assist them in developing integrated processes that would help them manage their unique transfer needs efficiently. Central Logic’s consultative approach allowed Maimonides to get the most out of their software implementation. “With everyone working together, the project was delivered on time and within budget,” said Walter Fahey, CIO of Maimonides Medical Center.

7. Engage IT in the process

Because Maimonides transfer center activities are managed through a web-based solution, and because that solution integrates with multiple other technology platforms, IT played a key part in their successful transfer center implementation. Alexandra Weinstock, Director of Patient Flow Management and HIS Systems, said, “IT’s main focus was to integrate Central Logic with our registration, clinical, and patient flow systems for the most efficient and seamless transfer of patients.”

Maimonides’ IT department worked diligently with transfer center staff to develop new transfer center alerts and email functionalities. They developed an interface with their EHR so in-patient and ED staff could receive the electronic summary from the transfer center system before the patient even arrived in the ED. The Hospital Transfer Summary, a fax-based tool, was implemented to receive documents from other facilities. Additionally, IT was helpful in educating and supporting the hospital staff. Without a strong relationship between the transfer center team and the IT department, the transfer center would not have been a success.

8. Utilize existing resources intelligently

The implementation team decided to locate the transfer center right in the hospital, allowing them to easily align the new transfer center staff with existing teams. Sommer explained, “Our strategy for the transfer center was to utilize some of the existing resources. The Patient Access staff, Hospital Transport team, Communication Specialist staff, and Environmental Services team are now all housed with the transfer center.”

Maimonides’ setup allows related hospital teams, including the transfer center team, to work closely together. For example, the Patient Access staff works with the RN Transfer staff and the unit nursing staff to ensure that a bed is available prior to the patient’s arrival and that the insurance needs are reviewed for the transfer.

9. Find a great ambulance dispatch team

Maimonides set up a direct phone line to the ambulance dispatcher and has the capability for instant communication. The two teams work together and discuss patient cases when there are delays or issues. This relationship has ensured faster, safer transport of patients who are admitted through the transfer center.

“We are fortunate to have a great team to work with for transferring our patients to Maimonides. Our ambulance department has a dedicated bus available 16 hours per day to assist with transfers. This system ensures that we are bringing our patients into the organization as quickly as possible. It’s definitely a plus for physicians and patients,” said Sommer.

Maimonides-Ambulance

10. Be flexible

Throughout the entire process, Maimonides has not been afraid to try new things, especially when it comes to working with others. For example, Transfer Center employees had never thought about picking up patients from home, but they quickly realized that doing so is a really good practice. They now call the physician to make sure he or she would like the patient to come to the hospital. The Transfer Center also works with families out of state to ensure that each patient has a safe transition of care.

Maimonides is also working with skilled nursing facilities to enhance the clinical patient information received by the ED for assessment and treatment of the patient.

“We are always eager to work with physicians and patients’ families to have a positive outcome,” said Sommer.

TRANSFER CENTER DATA POINTS: SEEING THE IMPACT

Maimonides’ return on investment (ROI) for its transfer center initiative came within months. Almost immediately, the transfer center team recognized the new center’s impact on transfer volume and hospital performance.

The transfer center’s value impact started with the center’s ability to manage all transfers associated with the hospital. Previously, the transfer process was fragmented and managed inconsistently by a variety of people and organizations. Transfer activity was not effectively tracked; and the team believes that many potential admits were lost to competing facilities.

One indicator the Maimonides team uses to track their success is to compare monthly interhospital transfers year over year. They saw an immediate jump in interhospital transfers. As they track the data they continue to see a much higher number of this type of transfer.
On average, Maimonides more than doubled the number of monthly interhospital transfers they handled compared to what they were handling before their new transfer center.

The Maimonides team also began measuring the total number of transfers, not just interhospital transfers. With their new tools and processes, they began tracking the transfers that came from physician offices, skilled nursing facilities, ambulatory sites, self-referrals, and more. This information gives Maimonides better insight into where their patient flow is coming from.
In the transfer center’s first year, Maimonides processed 4,164 total transfers. This number greatly exceeded the management team’s expectation of the transfer center’s impact.

As the Maimonides team looked for the story behind the numbers, they came to some conclusions as to what was contributing to the increase:

  1. Referring physicians and providers have greater awareness of the hospital’s services and more trust in its ability to quickly care for their patients.
  2. Maimonides’ staff work more efficiently together, discussing cases and resolving issues that delay patient care.
  3. Increased insight into transfer activity has allowed the Maimonides team to identify and reduce inefficiencies in their processes—improving the quality of care.

Just a few months after the transfer center opened, Sommer commented, “Our processes have proven so successful, we are hiring another full-time nurse to increase our team’s capacity.”

Maimonides continues to monitor transfer volume increases and plans to expand the transfer team accordingly—ensuring that the hospital provides better, faster care for all patients. The team recognizes that there is room to grow but is happy that they have gotten off to such a solid start.

“We knew there was a great opportunity for us to improve our transfer processes and hence improve patient care,” summarized Sommer. “A year after we went live, the positive impact we’ve made so far is beyond our initial expectations. It’s very satisfying for everyone on the Maimonides team that was involved in getting the transfer center off the ground.”

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About Maimonides Medical Center

Maimonides Medical Center, Brooklyn’s preeminent healthcare provider, is one of only 25 hospitals in the nation to achieve outstanding patient outcomes in all three categories of care that are measured annually by the federal government: heart attack, heart failure, and pneumonia. Widely recognized for its major achievements in advancing medical and information technology, Maimonides has 711 beds and over 70 subspecialty programs.

For additional information on the nationally recognized clinical services at Maimonides Medical Center, visit www.maimonidesmed.org