Case Study: How St. John’s Increased Patient Acceptance Rat

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In 2011, St. John’s Hospital in Springfield, Illinois instituted an innovative patient transfer program called SJS CONNECT. A typical transfer center coordinates in-bound transfers of patients from providers’ offices into acute care hospital settings where a higher level of care can be provided.

Through the efficient use of SJS CONNECT Regional Transfer Center, St. John’s has increased quality patient care outcomes and provides quicker assistance for patients in need. Additionally, St. John’s continues to see improved customer satisfaction ratings, an increased volume of referrals, and positive contributions to the hospital’s financial performance.

Hospital systems nationwide are recognizing the competitive and patient care advantages achieved through patient transfer centers. St. Johns’ pioneering patient transfer techniques have helped establish industry best practices and demonstrate the positive impact of using healthcare technology to increase system-wide patient flow.

In its first year alone, SJS CONNECT Regional Transfer Center:

  • Resulted in a contribution margin of more than $16 million
  • Helped St. John’s increase patient transfers by 40%
  • Increased patient acceptance rates from 67% to 97%

I. Succeeding in a Competitive Market

StJohnsHospital-400x227St. John’s Hospital in Springfield, Illinois (SJS) is the flagship tertiary care hospital for the Hospital Sisters Health System (HSHS)—a multi-institutional network that sponsors 13 hospitals across Illinois and Wisconsin. In 2008, SJS set a goal to be the preferred provider of healthcare services in its region. Located in a competitive market filled with innovative healthcare providers, SJS needed a compelling strategy to achieve this vision.

 

The SJS team immediately identified operational hurdles that were obstructing patient flow and restricting the organization from becoming the preferred regional provider. As a tertiary hospital, SJS received hundreds of patient transfers into its system each month. These referrals were outsourced to a call center. Staffed by non-clinical receptionists, data capture in the call center was often unsatisfactory, and a negative association with call center reliability led many providers to pursue separate referral systems. Additionally, SJS lacked an integrated database for data capture, meaning referral intelligence metrics went uncollected. As a result, SJS’s average monthly acceptance rate was 67%.

Communication was rare to nonexistent between referring and receiving physicians regarding milestones in patient care. This led to ill-defined discharge handoff processes. Furthermore, patients entered SJS through seven different access points due to lack of standardized procedures.

With multiple referral systems and entry points, limited communication, and no central database to establish metrics and baselines, SJS had lost visibility of incoming transfers to the hospital. These conditions lent negative associations to the SJS brand.

SJS recognized these obstacles to becoming the preferred regional healthcare provider. As such, hospital administrators collaborated to define critical success factors to revamp their current operations. SJS determined the hospital needed to:

  1. Create a single “front door” and common referral processes
  2. Adopt an information system to deliver real-time business intelligence and reporting
  3. Find an IT-enabled communications system
  4. Manage infrastructure through a steering committee and a reliable provider panel managed by an enabled Medical Director
  5. Improve ease of access for referring providers
  6. Develop a dedicated panel of clinical specialists with a philosophy to accept patient transfers

II. The Solution

Based on an intensive internal and regional assessment, St. John’s decided to create a regional transfer center called SJS CONNECT. The center’s objective was to improve efficiency and communications across the HSHS network. Transfer centers had proved effective in the healthcare industry, and the processes specifically addressed SJS’s critical success factors.

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

“The vision was to create an umbilical cord that would bind the community’s physicians and patients to our hospital and our system,” said Dr. Gurpreet Mander, medical director for SJS CONNECT. Mander teamed up with SJS CONNECT Director Bryan Finn, and together they created a transfer center to address St. Johns’ needs.

Researching transfer center trends, Mander and Finn compiled best practices and developed an innovative arrangement. Since its creation in 2011, SJS CONNECT has evolved and refined its processes. In its first year alone, SJS CONNECT increased patient transfers by 40% that resulted in a contribution margin of more than $16 million to HSHS.

The following points summarize several  transfer center best practices that the SJS team has adopted. These practices help optimize transfer center processes, thus increasing patient admissions and decreasing patient leakages.

Transfer-Center-Diagram-580x380

III. Transfer Center Checklist

1.   SJS CONNECT staffs its transfer center with seasoned, critical care RNs. All calls are answered by these experienced clinicians. Nurses are able to provide appropriate triaging to direct patient admissions. This practice has increased the accuracy and reliability of patient placement and data collection, helping SJS CONNECT gain the trust of referral sources. Mander states, “Clinicians are better able to serve the needs of patients and doctors because of their critical thinking skills and ability to help with triage and patient placement.

2.   Every transfer is accepted with a gracious and ready “yes.” Transfer centers exist to help a health system swiftly and accurately admit patients. As such, every transfer request SJS CONNECT receives is answered with a “yes.” Referral sources rely on SJS CONNECT, knowing they can immediately get their patients to the higher level of care needed. “If a patient is being transferred it is because a physician has determined they immediately need a higher level of care,” states Jason Burch, EMT, EMD, Director of Patient Transfer Centers at Central Logic—a patient flow software solution provider. Immediately accepting patients is a patient care best practice.

3.   In its new model, SJS CONNECT houses the transfer center RNs, regional nurse coordinators, and switchboard staff all in one central location. The center utilizes an open floor plan for better communication. Additionally, to streamline communications throughout the HSHS network, all referral systems are redirected to SJS CONNECT.

4.   “One of the game-changers for our system has been the ability to connect referring and receiving clinicians together, typically over the phone, via our transfer center,” noted Finn. Using transfer center technology, referring providers are immediately connected with a receiving physician to coordinate patient care needs. Transfer center software collects and sends critical details and diagnoses from the referring group to the receiving group. This allows the receiving group to begin prepping for the patient’s specific needs, speeding the care delivery process.

5.   Not only has St. John’s connected clinicians together, SJS CONNECT facilitates seamless integration with regional transport assets. SJS CONNECT can activate air or land transport via relationships with local and regional ambulance services as requested by the referring facility. Furthermore, SJS CONNECT facilitates the dispatch of the St. John’s specialty transport teams: maternal, pediatric, and neonatal.

6.   In addition to the right people being involved in the transfer center, special attention was given to creating a data management and workflow system that was real-time and transparent. “We had correct processes,” says Mander, “but we had absolutely nothing to manage data, and our perspective of referral trends was indistinguishable.” SJS realized they needed a customizable and robust software solution to collect, manage, and track patient data.

 

stjohnstransfercenter-400xXIn 2011, SJS CONNECT implemented Central Logic Transfer Center™, the industry’s leading transfer center technology solution. Transfer Center allows SJS CONNECT to securely capture critical patient details and pool data in one scalable location. Observing data trends through Transfer Center reporting, St. John’s appropriately utilizes its resources and is able to handle a greater volume of patient admissions and transfers.  All calls and call information are recorded.  And additionally, on-call physician schedules are automated and instantly available to the transfer center RNs.

Using Central Logic Transfer Center, SJS CONNECT tracks calls by hospital and by services to assess trends and to set targets for its regional liaisons. Data is also used to examine out-migration (“leakage”) by hospital and by service, including analyzing in-system and out of system hospital transfers. This helps St. John’s identify referral patterns and target its marketing efforts. Additionally, using Transfer Center technology, SJS CONNECT manages and consolidates service recovery on all transfers that do not follow established protocols.

7.   SJS CONNECT is expanding the menu of services it offers referring facilities, including acute transfers and consultative services.  Also, the transfer center now supports telemedicine for acute neurologic consults and is adding Pediatric and ICU tele-consults in the coming months.

8.   One key component to the success of SJS CONNECT is the brand identity associated with the transfer center. Through consistent, accurate, and swift transfers, SJS CONNECT has proven its ability to deliver the highest levels of service. Establishing this brand identity is critical to ensuring referring groups continue to rely on St. John’s to provide care and recommend them to others. A high level of physician engagement and accountability, committed staff, and the support of hospital leadership has allowed the SJS CONNECT brand to flourish.

9.  Specific plans were developed to reduce outmigration from HSHS Illinois hospitals. To accomplish this, SJS began studying outmigration rates for HSHS hospitals in other states. The outmigration team also studied all transfers out of the system hospitals.

As an established business unit, SJS CONNECT has created a new system for accepting and tracking patient referrals. Completely overhauling their previous operations, SJS CONNECT utilizes innovative transfer center technology to give hospital administrators the data collection, communication tools, and visibility they previously lacked. This has allowed them to address the challenges obstructing their preferred provider status.

“The transfer center, in my vision, is an arena of innovation in healthcare access,” commented Mander. “As comprehensive data collection areas, transfer centers are a critical source of both business and population health data.”

Transfer Center Building Blocks

For those creating a new transfer center or looking to implement leading practices in their current center, consider the building blocks SJS CONNECT transfer center has used to create their foundation:

  1. Use of experienced clinicians (seasoned RNs) to staff the transfer center
  2. A gracious and ready “yes” to all requests for services
  3. Housing of all referral groups in one location
  4. Consistent communication of patient care milestones between referring
  5. Integration with transportation assets
  6. Use of robust software solutions for referral data capture and communications
  7. Delivery of a full menu of services: acute transfers, consultative and next day appointment scheduling, etc.
  8. Establishment of brand identity associated with the highest levels of service
  9. Creation of specific outmigration reduction plans

IV. Transfer Center ROI

Innovative procedures and dedicated leadership have enabled SJS CONNECT to become an industry-leading transfer center. Additionally, the transfer center has levied continuous ROI for the HSHS system.

Originally, SJS CONNECT established goals in the areas of quality, service, growth, finances, and staffing. With the help of exceptional staff and appropriately implementing transfer center technology, SJS CONNECT has not only met their goals, they have exceeded them.

In the first year after implementing the SJS CONNECT regional transfer center, total requests for transfer increased 34%, and actual patients transferred to St. John’s increased 40%. Patient acceptance rates increased from 67% to 97%.  SJS CONNECT resulted in a contribution margin of more than $16 million to HSHS in its first year alone.

“It’s all about the ease of access,” said Finn. “Facilitating transfers, providing access to information, physician-to-physician consulting, using RNs to answer calls–all of these things are critical to a transfer center in providing easy access for referrals and quicker care delivery for patients.”

Two HSHS facilities were engaged as pilot locations in 2011. Since then, over 70 new facilities have been added to the SJS CONNECT referral system. SJS CONNECT has learned that one of the driving forces in its success is a relentless focus on the patient and the remote hospital team.

StJohnsRegTransfersGraph-650x361

Recognizing its trajectory, SJS CONNECT continues to take steps and move forward. As a thought-leader in the patient flow arena, St. John’s has next-generation plans for SJS CONNECT. Administrators foresee the transfer center providing in-office appointment scheduling, acting as a case and disease management service, facilitating a telemedicine network for specialties such as neurology, neurosurgery, behavioral medicine and dermatology, assisting patients with physician selection, and much more.

Using SJS CONNECT Regional Transfer Center, St. John’s has increased quality patient care outcomes and provides quicker assistance for patients in need. Additionally, St. John’s continues to see improved customer satisfaction ratings, an increased volume of referrals, and positive contributions to the hospital’s financial performance.

Transfer centers nationwide are levying the same results. As such, pioneering institutions continue to implement transfer centers to achieve operational and patient-centric efficiencies. Indeed, transfer centers are improving the way organizations care for patients, saving lives and appropriately utilizing hospital resources.

 

About St. John’s Regional Transfer Center

St. John’s Hospital (Springfield, IL) is an academic referral center; the flagship tertiary care hospital of the Hospital Sisters Health System. St. John’s was founded in 1875 by the sisters of the third order of St. Francis. The mission has grown into 13 hospitals in Illinois and Wisconsin, with operating revenues of $1.9 billion. St. John’s is licensed for 431 beds and serves the Central and Southern Illinois area. St. John’s has more than 3,000 staff members and is one of the largest employers in the Springfield area. The medical staff totals nearly 700 doctors, podiatrists, and dentists.

 

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