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Pre-planning, good communications pave the way
A good accepting center plan paves the way for smooth transfers with advanced planning and streamlined communications.
At Cincinnati Children’s Hospital Medical Center, for example, several years of ongoing meetings with community physicians created awareness of how the facility’s ED handled transfers. It also engendered valuable interpersonal relationships among medical professionals, while the facility improved communications through centralized phone and computer transfer capabilities.
At Lutheran Hospital in Fort Wayne, IN, similar strategies were employed. Shelly Miller, RN, BSN, division director of emergency services, responded to staff, patient, and physician frustration by instituting a centrally coordinated Bed Book Department. The department is staffed with a nurse who is the main point of contact for transferring facilities, and a toll-free telephone number can be called ahead of time to learn about procedures and to arrange for transportation.
At the center of both success stories is one-stop communications. Statline is the name of the communications hub for the ED, says Joseph Luria, MD, medical director of Statline at Cincinnati Children’s.
"All incoming referrals, squad reports [telemetry], hospitals transfers — basically all communications and the activation of trauma teams — are handled through Statline," he says.
Lutheran’s system is likewise centralized. "Once [the Bed Book Department] receives a call from a physician or a nurse in an outlying facility, they become very proactive and respond immediately," Miller adds. "They get any additional information they need — meds, diagnosis, level of care required — and assign the appropriate room at that time and assign a room number as well."
Cincinnati Children’s has had its Statline since 1990, but originally it was set up as a central hub for ambulances, recalls Richard Ruddy, MD, director of emergency services. "But from our perspective, 25% of our visits are referrals from physicians’ offices, pediatricians, and family practitioners, and a significant portion comes from other regional facilities," he notes.
A small area with a desk and chair was set up in the ED. The central operator handles all calls coming in to the ED from the primary physicians, helicopters, emergency medical services (EMS), their own transport team, parents seeking medical advice, and so on.
The meetings with community physicians, so critical early on, occurred less frequently as the years passed. However, improvements continually were made to the system. "Over the last couple of years, we’ve tried to continually standardize the information the operator from Statline gets from the outside, so that when communication from physician to physician occurs, we can go into our EMStat computerized record [Med-Media, Harrisburg, PA] and see what the operator already has typed in, such as what the injury was," Ruddy explains.
Before the changes at Lutheran, Miller recalls, there was quite a bit of confusion surrounding transfers.
"Because patients might arrive from EMS in admitting, and occasionally even directly to a patient floor, no one knew exactly what to do with them," she says. "Other hospitals, and especially physicians, were calling different areas: ED, inpatient, [intensive care unit]."
Now when an outside party calls the Statline, the operators know who they need to contact if tertiary care is required, Miller says..
"In the ED, they will accept the patient without question and get the transfer going," she explains. "Meanwhile, if they need internal medicine or cardiology, the operator will communicate to that physician to accept the patient as well."
Since the nurse is familiar with the different types of patients the hospital receives, patients are assigned to an appropriate bed as quickly as possible, Miller adds. "They can also take admission orders from the doc, so there’s no need for an extra call," she notes.
Lutheran has expanded its Bed Book Department hours from an initial eight hours a day, Monday-Friday. Now the department has "24/7" coverage — by RNs 10 hours a day, five days a week, and by the nursing supervisor (via portable phone) the rest of the time.
Miller has had to educate outside physicians about her process, through newsletters, mailings, and open houses. "It has absolutely facilitated transfers and better utilization of our bed space," she says.
At Cincinnati Children’s, the Statline is staffed by two full-time workers. "A year ago, we discovered we could find some documentation of appropriate follow-up in 67% of our ED cases," says Luria. "One year later, that has gone up to 90%, with more specific and better outcomes."
And of course, serving referring physicians well is critical, Ruddy adds. "We’ve got to keep these guys happy; they are the bread and butter of the [referrals of] sicker kids," he notes. "And they could just as easily be calling to Louisville. But the feedback from our community physicians has been very positive."
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