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Implement New Transfer Center Model
Joseph Nammour
Beth Israel Deaconess Medical Center
Introduction/Problem
The Interventions
In 2016 a hospital-wide audit was performed by PWC and found the following deficiencies related to our interhospital transfer processes:
• Lack of a strategic vision and plan for inter-hospital patient transfer management and patient flow.
• No singular, consistent process for accepting & tracking patients requesting transfer and related medical
information.
• No clear philosophy or priority setting algorithm regarding acceptance or rejection of transfer inquiries.
The inability to reliably provide timely decision-making, access to needed tertiary and specialty services, and
follow-up to transfer requests can compromise patient care and safety. Additionally, capacity challenges and suboptimal referral relationships could compromise the organization’s ability to grow strategically important services.
The processes for data capture and performance management are labor intensive and do not optimally leverage
technology, and the opportunity cost from lost transfers is high.
Implementing a new transfer center model will impact effectiveness, efficiency, timeliness, equitability, safety,
and patient care.
Aim/Goal
Goal: Increase the % of our population admitted via outside hospital transfer from 10% to 12%, and develop
methodology to track and analyze “appropriate” transfers.
Auxiliary goals include providing easy access to care for patients and physicians and facilitating the transition of
care, facilitating data collection on transfers to drive decision making within BIDMC and the network, and ensuring
that BIDMC is strategically filling available beds according to hospital strategy and clinical necessity.
The Team
Identified gaps in data collection, which led to a plan to improve this process by creating a form to capture all
declined ED-ED transfers & a system to track performance data on accepted & declined transfers over time.
Implemented a weekly huddle with admissions facilitators to review cases, barriers, and delayed transfers.
Created a meeting structure to maximize productivity. The Operations team includes representatives from IS,
Telecomm, and Facilities; while the Clinical team has MD representatives spanning the Medical Center.
Held workshops and training sessions to gather feedback from staff and introduce workflow changes to bed
placement & admission facilitator roles to create structure and enhance communication.
Renovation of the existing workspace to modernize and create a more collaborative environment.
Developed a policy to establish standards applicable to patients transferred to BIDMC from other facilities.
Results/Progress to Date
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Outside Hospital Transfer % FY17 - Present
PWC
Audit
Chartis
Engagement
FY17
AOP
Goal
Medical
Director
Hired
FY18
AOP Goal: Increase the % of our population admitted via outside hospital transfer to 12%
Demonstrates % growth of inpatient population admitted via transfer since FY17. Project began in early 2017.
Source: Performance Manager, Hospital Dashboard – Weekly Activity; *excludes Neonatology, OB/GYN, and Psychiatry*
For more information, contact:
Joseph Nammour, Management Engineer II, Office of Improvement & Innovation - jnammour@bidmc.harvard.edu
�Implement New Transfer Center Model
Joseph Nammour
Beth Israel Deaconess Medical Center
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
IP Hospital Transfer % vs. Code Help Alerts & Activations
10
8
6
4
2
0
Code Help Alerts
Code Help Activations
IP Transfer %
Code Help Alerts & Activations
IP Hospital Transfer %
More Results/Progress to Date
Target
The percentage of inpatient transfers is increasing despite consistent code help alerts & activations.
Source: Performance Manager, Hospital Dashboard - Weekly Activity; ED Quality Assurance Utilities, Code Help Stats
Lessons Learned
The capacity challenges that BIDMC faces in its current state drive many of the decisions made on a daily basis.
Transfer Center staff work very hard every day, but they didn’t know what they didn’t know. Without an
organizational transfer strategy and reliable data to refer to and analyze, they were not operating at peak
productivity, highlighting the need to structure data capture and enhance communication and collaboration.
Creating subcommittees & specialized (operations and clinical) teams to tackle specific pieces of work was a
crucial part of this process in ensuring consistent progress was made in areas of their particular expertise.
Next Steps
IS is developing an interactive Transfer Dashboard that can display various quality metrics for specified date ranges.
Top left: Admission Type by CMI Group
Bottom left: Admission Type by Admitting Department
Top right: LOS Saved/Excess Days (Diff in days between Expected & Actual LOS)
Bottom right: Admission Type by Payor
Source: Transfer Log
Purchase and integrate Teletracking product
Standardize decision making for how transfer requests are prioritized
Add administrative resource for Transfer Center
Brand and market Transfer Center to external customers
Develop a quality review process & capture patient feedback
For more information, contact:
Joseph Nammour, Management Engineer II, Office of Improvement & Innovation - jnammour@bidmc.harvard.edu
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Joseph Nammour (<a href="mailto:jnammour@bidmc.harvard.edu">jnammour@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Office Of Improvement and Innovation
Project Team
Peter Healy
Stan Lewis
Marsha Maurer
Mary Jo Brogna
Sheila Barnett
Rich Wolfe
Alexa Kimball
Julius Yang
Manu Tandon
Sarah Moravick
Kristin O'Reilly
Joseph Nammour
Julie Dasey
Leon Sanchez
Mike Gavin
Duane Pinto
Lauge Sokol-Hessner
Michael Cocchi
Todd Sarge
Jen Stevens
Blair Wylie
Ben Schlechter
Edward Rodriguez
Larry Markson
Ayad Shammout
Leonard Markowitz
Sandy Denekamp
David Baker
Dana Dahill
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Implement New Transfer Center Model
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Equality
Patient and Family-Centeredness
Safety
Timeliness