By Darin Vercillo, MD
Chief Medical Officer, Central Logic
The call came into a health system transfer center: A patient at a community hospital needed a vascular or neurosurgical consultation after presenting with dizziness and facial numbness, along with worsening visual changes and headaches. CT angiography revealed a dissecting carotid aneurysm.
Time is of the essence in getting these types of patients to advanced care, yet this interfacility transfer took three hours to complete. Meanwhile, the patient experienced changes in vision and mental status, and she ultimately had a seizure. Eventually, she was flown to a tertiary care hospital for an intervention and had a successful outcome. But the delays in transferring this patient could have brought about a very different — and potentially tragic — result.
I’m intimately familiar with the details of this situation because it happened to a patient under my care during an overnight shift at a community hospital.
Naturally, we want to understand why these delays occur and how they can be avoided. As you might expect, there are no easy answers. In the case of my decompensating patient, the transfer center I contacted initially was lacking a number of critical elements, including well-designed workflows and protocols, clear visibility to facility resources, and a comprehensive overview of physician schedules.
These shortcomings can be remedied with the right mix of staffing, technology, and best practices. What isn’t so easy to fix is a misalignment between physicians and health systems, as well as among different physician groups, which is often the root cause of other issues that hinder great patient care. This cultural disconnect may be encapsulated in the following contrasting (and commonly held) perspectives:
- “We will do everything within our power to accept transfers and deliver the appropriate level of care to these patients on a timely basis.”
- “Patient transfers represent a disruption to my schedule…a drain on my already limited time.”
- “I am fine with accepting transfers as long as I’m assured that I have the consulting and admitting support that I need.”
Here’s a prime example of how cultural misalignment plays out in everyday life: When referring physicians request a patient transfer, they often receive “conditional acceptance,” meaning the initially contacted accepting physician says “yes,” but only if a specialist or subspecialist agrees to consult on the case or a hospitalist agrees to admit. Finally, after numerous calls and much time spent on hold, the health system provides a definitive answer: yes or no. This is one of the leading causes of delays in transfers and patient care, not to mention a major source of frustration for referring physicians.
Sooner or later, referring providers reach a breaking point: After so many calls, delays, and/or transfer denials, they’ll hang up and call another health system. And, believe me, they’ll share their negative reviews with their colleagues. The net result isn’t just diminished patient care or dissatisfied clinicians; it’s also the “leakage” of patients and revenues to other health systems — and who can afford that during an era of so much financial stress?
Provider Engagement Program: a solution available to all
The patient transfer scenario I shared at the beginning of this article is by no means rare or isolated. In my work with health systems across the country, I frequently hear about the challenge of getting physicians to accept potential inbound patients. But, rather than assigning blame to one group or another, I believe that the problem is the cultural misalignment described above. Accordingly, I see the solution as bringing differing cultures into alignment.
This is the driving principle behind the Provider Engagement Program (PEP), which is now available to all Central Logic clients as part of our comprehensive healthcare access and orchestration solution.
At its core, PEP is a collaborative initiative, with health system and physician leaders working side by side, guided by Central Logic’s clinical consulting experts, to design workflows, establish single provider acceptance (SPA), and create transparency through accurate, real-time analytics. Invariably, these efforts lead to the replacement of unwieldy complex workflows with a much simpler approach to patient transfers, as well as happier and more engaged physicians.
Along the way, all key stakeholder groups discover that they benefit from this transformation. Health systems achieve accelerated acceptance of patient transfer requests, fewer transfer denials, less leakage to competitors, and enhanced financial performance. Accepting physicians feel better supported in their decisions, benefiting from an elevated “trust mark” among their peers, and they enjoy a more streamlined process. Referring providers are pleasantly surprised to find out that they’re making fewer phone calls, spending less time on hold, and getting their patients to the appropriate level of care without delay. By making the process easier for referring providers, these health systems bring in even more patients — a crucial consideration in today’s highly competitive environment.
Most importantly, every care orchestration decision reflects the patient’s best interests and contributes to optimal clinical outcomes.
It’s been gratifying to see how enthusiastically health systems and providers have embraced PEP — but even better to witness the fruits of their labor. For instance, after implementing PEP, one client slashed its referral acceptance time from more than six hours to under 30 minutes, and health system leaders believe that can be whittled down to less than 15 minutes within the next few months. The same organization surveyed its physicians about their satisfaction with the initiative and received such positive feedback that the program will be rapidly rolled out in another state (much more quickly than normally would be the case with this health system’s new programs).
Health system executives have been impressed with PEP, too. The CEO and COO appreciate how it has facilitated the alignment of the organization’s priorities with those of their providers. Plus, now they clearly understand, via analytics dashboards, how strengthened provider engagement creates a reputation for the health system as the first place to call for future transfers. Of course, the CMO sees accelerated patient care acceptance as a key contributor to enhanced patient care and improved outcomes.
Lastly, but certainly not least of all, implementation of PEP has helped the health system’s providers feel a deeper affinity for the transfer/access center as a means to improve their patient care and make their lives easier, instead of an impediment to their work or a drain on their time. They experience greater clarity about transfer processes and the acceptance of patients.
All of this leads to deeper trust in the health system and a sense of ownership in the transfer/access center — we’ve heard physicians say things like “this is my transfer center.” These are intangibles, to be sure, but still vitally important in building and maintaining strong alliances between health system transfer centers and the providers who are so crucial to the delivery of timely, high-quality healthcare.