Patient Movement 101: What Healthcare Systems Need to Know to Work Better

The ins and outs of interfacility patient transports — the processes, workflows, resources, reimbursement, and decision-making — aren’t something most people think about.

Yet how patients move within a healthcare system impacts not only the patient being transferred, but also the transport vendor and the on-call physician, as well as the hospital’s program director, board members, and local and state stakeholders. How patients move influences much more than most people think, and its impact can be seen on the national level as we look at our healthcare statistics and trends. Let’s learn a little more.

A Patient Arrives at the Emergency Room (ED)

When a patient arrives at the ED, a triage nurse assesses the severity of their condition based on vital signs, symptoms, and medical history. After triage, a physician must determine the individual’s subsequent needs: does the facility have the expertise, resources, and equipment to treat this patient? If not, the ED team might initiate an interfacility transfer.

Approximately 70% of a hospital’s inpatients are processed in through the ED, and the majority arrive by Emergency Medical Services (EMS). For the most urgent conditions — such as myocardial infarction, stroke, sepsis, and major trauma — EMS protocols specify emergent transport to the most appropriate facility for immediate treatment. But once these patients are stabilized, they might still require a transfer.

Patients often qualify for an emergent transfer to another facility because their condition requires a level of specialization or testing that the initial facility cannot offer. For example, a trauma patient who requires surgery might be transferred from a critical access hospital (one with 25 or fewer acute care beds) to a Level I trauma center. Before the COVID-19 pandemic, smaller EDs averaged the highest transfer rates, at approximately 5%.

Patients can also be transferred due to a lack of capacity (which is happening much more frequently during our current staffing crisis), patient preference, or insurance coverage issues. In non-emergent situations, a patient might require transfer for elective surgery, to be closer to home, or to move to a more suitable environment in order to free up capacity for high-acuity patients.

The Patient Needs to Be Transferred

Time-critical cases require fast consideration of the patient’s clinical situation, current needs, potential outcomes, and the available resources. Facilities must have standardized processes in place to quickly evaluate their capacity for accommodating a patient who requires a higher level of care. Hospitals can use acuity scores to prioritize which patients should be first on the list for a transfer, ensuring that low-acuity cases do not inadvertently bump higher-acuity cases down the list.

Hospitals must also have strong connections with other hospitals within the region, as they will need to locate and confirm an appropriate destination. When bed capacity drops across a region — such as during COVID-19 — finding a facility that can receive the patient can be a challenge. Clinicians sometimes spend hours on the phone, calling half a dozen facilities or more in search of a bed. For facilities using Motient’s Mission Control solution, the process is much easier. Clinicians simply enter a pending transfer into the application and continue caring for patients, as the Motient team will contact them once an appropriate, available destination is confirmed.

What kind of prep work must be done?

Once an appropriate placement is found, the ED team must coordinate the logistics of safe, reliable patient transport. The team may need to contact multiple transport vendors, as some may be unavailable, or may lack the capabilities for safe transport for certain patients. An incomplete understanding of the patient’s condition can lead to inadequate resources during transport, and thus to adverse events.

Throughout the transfer process, physicians at both the referring and receiving hospitals must be updated about any changes in the patient’s status. There should be open and continual communication between the medical command and the transporting vehicle. The key elements of a safe interfacility transfer include communicating the transfer decision; stabilizing and preparing the patient; choosing the appropriate means of transport; determining the degree of monitoring required during transport; and ensuring a smooth patient handover to the receiving facility. While Motient’s Mission Control solution provides essential support for all of these functions, hospitals without a patient transport tool may struggle to manage the logistics of the transfer process on their own.

Why is a standardized infrastructure necessary?

As the pandemic has shown us, patients who spend too much time in the wrong level of care have a ripple effect across healthcare, impacting the number of beds available for high-acuity patients. Ideally, hospitals and other healthcare facilities should be able to access regional patient transport data to give them insight into capacity blockages, available specialty resources, and ongoing needs.

Hospitals that establish an overarching process for how they will handle interfacility transfers will be better equipped to make fast, efficient choices to reduce risks and maintain care quality. By specifying best practices for certain clinical conditions, patient circumstances, and system and staffing constraints, hospitals can conserve limited resources and deliver patients to the best possible care setting.

More and more hospitals are beginning to collaborate with their regional counterparts to develop a better infrastructure for patient movement. For example, larger academic medical centers might agree to receiving patients from urgent care centers and rural hospitals, while smaller hospitals might commit to receiving lower-acuity patients plus a particular subspecialty. When hospitals work together, they can better ensure that all patients receive the care they need without blocking movement within the larger ecosystem.

While regional collaboration was important before COVID-19, it is now essential. Motient’s Mission Control gives hospitals the tools they need to streamline the transfer process. As hospitals refine their own patient movement performance, they will be better equipped to partner with other facilities to establish a regional transfer infrastructure—one that ensures every patient is treated in the best possible location for his or her condition.

To learn more, read this article by Motient co-founder Martin Sellberg, MD, FACEP, How Patient Movement Benefits from Standardized Acuity Scoring in HIT Consultant.

Turn, Turn, Turn: Lessons Learned from Rural Life That Can Be Applied in Healthcare

Guest post by Motient co-founder Dr. Richard Watson

Growing up in the rural Midwest, I would never consider myself a “farm boy.” My parents were both PhDs, and although we had cattle and horses, hauled hay, and planted milo, I don’t think we would have qualified to be in the same class as the revered families that know what it’s like to depend on a series of variables that no one has control of to make a livelihood.

Understanding moment-by-moment the importance of coexisting with the land and the weather, respecting what you know and don’t know, and being humbled at every turn either molds character or destroys it. The whole idea seems merciless to me, but some of the most important figures in my life came out of that crucible. I have so many memories of those days, mostly happy, some wonderful, some sad, but many that are hilarious and representative of the chaos that humans, animals, and land can find themselves in.

I would sometimes work for the farmer who lived down the road from us and enjoyed seeing a pro at work and trying to get my head around how someone would choose that life. Harvest was the best in my mind: The moment when all the other moments would come together, and the beauty of the fields gave up their hard worked-for crop. Silage was by far the most mysterious to me. Cutting corn while still green and then blowing it into cylindrical towers where it would be left to ferment and become rich nutrition for livestock. Silos themselves are amazing: These monoliths of the plains are the icons of hard work. They are formidable to withstand the elements and their intended purpose.

The View from Inside a Silo  

I find it interesting that in healthcare, we refer to the silos of care. Certainly, this is true of patient movement. Sending facilities, receiving facilities, and transport services all have formidable foundations, and the infrastructure is an almost impermeable structure that seems limited by its own occupied geography. Standing in a silo, the walls are readily apparent. You become acutely aware of the limitations of your own space. When you do look out, the only view is straight up and is limited to a very small picture of the outside world. That limitation gives minimal data as to what the outside is really like. Healthcare mirrors this in the way we develop space in our own confined geography, but the view out is very limited. Amazingly, you can never see another silo from inside of your silo.

Building Fresh & New on a Strong, Clean Foundation

One of my jobs before harvest would be to clean out the silo. At the beginning of each harvest season, there would be silage leftover from the previous year. I would crawl in through one of the openings and begin shoveling the remains out. At first, it was the sweet fragrance of the fermenting silage, but it would quickly deteriorate into a stinky, wet, rotten mess! Much like health care, there is little interest and getting rid of the old and the rotten.

We continue to keep that covered.

Healthy Harvests — and Systems — Require Regular Maintenance

The future of health care depends on the constant, consistent, calculated dismantling of our silos. We have readily learned that we can’t have a never-ending supply of healthcare resources. We’re only beginning to experience the wave of the aging boomer population and the financial challenges ahead. The decreasing rural population and the regionalization of more and more services will require us to match patients more thoughtfully with medical services. Forming links to telehealth resources will help maintain transport and referral capacity and will be essential. Intentional, proactive communication between sending facilities, receivers, and transporters, will be the first step in understanding the needs and obstacles of the individual institutions. Forming these coalitions and including payers will actually give financial teeth to the decisions made.

The most important realization for health care is that we all have a place in this world. Fears that drive protectionist activity are limited page progress and unnecessarily unhelpful with what we know to be the future.

It is time to shovel out the old and prepare for a new crop.

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I have really enjoyed working with the knowledgeable and innovative staff within Mission Control! They have observed and created a dashboard that significantly meets our data abstraction needs. This information is in real time and we can access the data points we need very quickly. Mission Control has saved me hours of manual abstraction and I can now present this information to our physicians and leadership through creative charts and graphs. At Newman Regional Health, we are very excited to integrate Mission Control into our daily workflow and look forward to the valuable information the dashboard can provide!

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We started using Mission Control a few months ago because we were struggling with finding patient placement and transportation. Mission Control helped with that significantly. MC is very user friendly! All staff has been so kind and helpful! They are always prompt with assisting us and do a great job in keeping us up to date and informed on any progress they’re making whether that be with a phone call or a message through mission control. They continue to work until transport has been found! We would be lost without them!

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The Creation of Motient: Two Doctors See Possibilities in Challenges

After experiencing the hurdles of patient movement first-hand, two doctors decided to transform them.

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