The Language of Sickness: Indexing patients at the Intersection of Patient Assessment Scores

Patient assessment scores exist to stratify patients traditionally by using specific anatomical and physiological indices. An assessment score can help the health care team determine the appropriate triage, aid in decision-making through standardization of clinical findings, and objectively score the severity of the patient’s illness or injury.

A Snapshot of Patient Assessment Scores

Patient assessment scores are used throughout the healthcare continuum from nurse to physician and from outpatient to inpatient. Some scores inform decision-making, such as the Braden Scale, Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-AR), or the Modified Early Warning Score (MEWS). In contrast, others assess the severity of illness or injuries, like the National Institutes of Health Stroke Score (NIHSS), Glasgow Coma Scale (GSC), and Injury Severity Score (ISS).

A Common Language of Sickness

These scores exist as a universal language in medicine: Without having fluency in each other’s mother tongue, a healthcare professional in rural Kansas and urban New Delhi would understand a patient with a GCS of 7 or an ISS of 15.

These internationally recognized patient assessment scores allow healthcare professionals to gauge patients’ clinical conditions and potential needs based on units of physiological data. Others exist to assist in care decision-making within a specific scenario. Still, no current methods exist for identifying and quantifying into a common language the elements of a patient’s condition when hospital transfer is needed.

A Remaining Utility Exists Despite Score Saturation

With this wealth of scoring methodologies, a natural saturation occurs: How many is too many? Scoring system fatigue occurs, and some scores are naturally weeded out according to how much utility they provide. Certain scoring systems become mainstream while others get left behind because there are simply too many, too complex, or used in such rare circumstances that their lack of utility is the cause of their extinction.

However, none of the current scoring methodologies illuminate the unique variables and considerations inherent to adult interfacility transfers. Removing a patient from the resource-rich environment of a hospital setting requires a practical understanding of the level of care necessary during transport to maintain established stability, and the risk of patient deterioration outside the environs of a hospital, along with identifying the severity of illness or injury.

Interfacility Transport: Measuring More Than Miles

One of the current gaps in interfacility patient transport is not having guidance to clinical scoring that assesses the illness and injury severity and risk when taken out of the resource-rich environment of an ED or hospital bed. What is the best type of transport for a patient who needs a neurological intervention 60 miles away versus a non-time critical orthopedic injured patient at the same facility and their receiving hospital is 200 miles away? Before deciding on BLS, ALS, or critical care, air or ground, what questions must be answered?

The Acuity Index: Capturing Severity of Illness, Level of Care Needs, and Risk for Deterioration During Transfer

The lack of a method to objectively quantify the nuances present in adult interfacility patient transfers has created the need for the Acuity Index. The Acuity Index is based on decades of emergency medicine and medical transport experience specific to the context of emergent interfacility patient transfers.

The Acuity Index addresses the question of “how sick is this patient,” which informs the level or urgency in moving the patient to definitive care and the risk of patient deterioration during the transport process by capturing information in three key areas to guide transfer decisions.

1. Level of care that will be needed at the destination facility and time criticality of the working diagnosis

2. Physiological support or intervention that has been instituted to maintain patient stability

3. Common factors that contribute to the risk of deterioration during transfer

The information gathered under these categories stratifies and assigns a numerical value to each patient. The value reflects both the patient’s illness level or severity along with the level of care needed in the transfer process such that the patient maintains or ascends the level of care ladder through this acute phase of their clinical journey.

Creating a Common Language for Interfacility Patient Transfer

The value of the Acuity Index score is specific to patient movement. Other scoring systems can measure patient conditions and influence treatment options for future research, outcome measurement, and reimbursement purposes. The Acuity Index explicitly scores a patient’s condition as appropriate for transport between the sender, EMS services, and the receiver. It has a specific use and value applied directly to patient movement.

The Acuity Index introduces another language for the medical world in a transfer scoring system. However, instead of increasing saturation, the Acuity Index fills a much-needed gap: The Acuity Index asks eight questions, broken into three parts, to determine patient level of care, physiological support, and risk of deterioration. The Acuity Index asks straightforward questions that consider clinical workload, risk, transport, a prognostic perspective of the patient, all critical components of moving the patient between controlled and uncontrolled environments.

Mission Control Feature Alert: New Facility Reporting

At Mission Control, everything we do is with you — our customers — in mind. We’ve been hard at work to help you derive even more value from the analytics pages. We’ve heard your feedback — and we’re excited to announce we’ve improved the reporting to align with your requests.

Mission Control has a new layout that now provides more information, is optimized to efficiently provide fast access to important metrics, and — somehow — is even more beautiful to behold than the dashboards you have been previously using.

Even better? The new URL is also simpler and easy to remember: analytics.missioncontroltransfer.com.

There are multiple ways to access the analytics.

  1. Browser access from a standard workstation (bookmark the page for easier access)
  2. Mobile devices via the PowerBI App on mobile devices
    1. download the mobile app

New Features: Filtering, Drilling Down, Bookmarking, and Lassoing

Filtering

You can now filter at the top of the screen. This makes it simpler to find what you’re looking for: faster, easier, and more efficiently.

Drilling Down

Want to see more information about a mission, or get more specific about a certain time, day, or diagnosis? Now, you can drill through to Mission Details or Working Diagnosis to the Weekday / Time of Day page.

Any time you see the “Finger pointer” icon for right click to drill through and see greater detail. For example, any time you see a Mission # you can drill through to the details page to view the patient details and mission notes.

Mission Control Facility Reporting – DEMO – Power BI — Watch Video

Lassoing

Selecting multiple categories is easier than ever before: Introducing “lasso” multi-select. You can now rope in multiple categories by holding down the left-click and dragging your mouse across categories.

Mission Control Facility Reporting – DEMO – Power BI — Watch Video

As a reminder, you can click all visuals to filter the rest of the content on the page, and you can layer this filter by holding the “Ctrl” key (or the “Command” key on a Mac). This layering ability works with the lasso selection tool as well.

Bookmarking

Find yourself setting the same filters every time you visit a page? Now, you can ave yourself some time and create a bookmark. For example, let’s say you always want to view “Time Critical missions with a Working Diagnosis of ‘Trauma’ in the past 7 days.” You can simply create a personal bookmark called “Trauma past 7d” and save yourself a few clicks (and cut down on the potential for mistakes).

It sounds almost too good, but we swear it’s true: You can set any filters and click on any visuals to create any kind of context – then simply head to the top right corner of the screen, click the bookmark icon, and select “Add a personal bookmark.”

New Pages

We’re also thrilled to introduce new pages to Mission Control.

Weekday / Time of Day Page

The Weekday/Time of Day page assesses patterns in diagnosis and vendor performance. For example, you can explore if there is a high concentration of Non-Time Critical orthopedic incidents on afternoon weekends, or if there is a high amount of revenue leakage from cardiac patient transfers when your cardiologist is on call. Or you can see if the median time for the vendor to arrive spikes on weekends overnight — if you want to assess a pattern in diagnosis and vendor performance, it’s at your fingertips.

Transfer Map Page

The Transfer Map page provides spatial visualization of transfers per destination. This is a basic map visualization of where your patients are being sent.

If you ever feel lost, or just want more information, just click on the “i” icon for onscreen tips and info. And don’t hesitate to reach out to analytics@cheyennemountainsoftware.com if you can’t find what you’re looking for.

Other News

Data User training content now available! A little bit of your time can give you greater mastery of your data and allow you to more proficiently unlock the important insights.

To access your account:

  1. Visit MissionControlTransfer.com
  2. Click the “reset password” link below the login button:
  3. You will have a link emailed to your inbox for setting your password and can then login at MissionControlTransfer.com

Remember: Using Mission Control for the movement of every patient creates data fidelity and increased value and increased value for your facility. In other words, the more you use Mission Control, the more you will get out of it!

For questions, feedback, or suggestions on how to make this experience more useful, please reach out to analytics@cheyennemountainsofware.com. And remember to bookmark — and visit often — analytics.missioncontroltransfer.com.

On the Frontier: With a Healthcare Crisis

*On the Frontier is an ongoing series exploring the realities of rural healthcare. If you would like to contribute or have questions, please contact us.

On the frontier, rural healthcare facilities endure experiences that other healthcare facilities don’t. Some are enjoyable aspects of small-town living, such as knowing your patients as friends and neighbors. But more complicated is living with scarcities in resources.  

There are daily financial, clinical, time, and resource-related realities of being a rural healthcare professional that urban and suburban peers might not consider. A harsh statistic rural residents face? From 1999-2019, rural areas suffered the highest age-adjusted mortality rates (AAMRs). In fact, during this time the disparity in mortality between rural and large metro areas tripled.

Why did this occur? A few reasons are most likely. There are far fewer resources available in rural healthcare facilities. There is generally far less money allocated. When patients need specialty care, the facilities they need to be transferred to are spread further apart.

People, including highly skilled people like doctors and other medical professionals, too often leave rural areas in favor of more densely populated regions. This, of course, means that there are fewer highly skilled people available — and even fewer specialists, such as cardiologists, neurosurgeons, or pediatric specialists. Of course, normal circumstances were further exacerbated by rural hospital closures and the COVID-19 pandemic.

The people who decide to stay on the frontier tend to be incredibly resourceful. They are excellent problem solvers and creative thinkers who aren’t shaken by much — essential qualities for rural healthcare.

Tightknit Communities Create a Unique Connection in Hospital Settings

Rural healthcare workers tend to know their patients not only as patients, as might usually happen in more urban areas but as neighbors — sometimes, even as friends and family. The lab tech isn’t just someone you meet at work; he’s your best friend from third grade. Likewise, your patients aren’t just “the hip repair in room 314” or even “Mr. Jones” — that’s Dave, your cousin.

There’s an intimacy in a small town that cannot be duplicated in an urban center. On the frontier, the people you work with are the people you live with.

Every patient doesn’t just have a name — they have a story. You don’t just know their patient profile; you know their families, where they went to school… You might even know how they take their coffee.

Fighting for Access to Resources

Rural healthcare professionals are aware of the challenges — and benefits — in the care they provide. But, despite ample evidence and rationale to provide better care and allocate more resources to rural areas, many pathways, processes, and access to funding are still difficult for many rural areas in America. As a result, even though 19.3% percent of the US population lives in what is considered a rural area, access to equivalent healthcare may remain elusive for them.

For medical professionals within the system, the fight for resources can feel like an uphill battle. Beyond their daily jobs, they are tasked with solving resource problems with many different people, offices, and bureaucracies.

On the Frontier: With Better Access to Quality Healthcare

Rural hospital facilities’ existence is dependent on champions. A person — or people — who will fight for their hospital, their peers, their patients, and their community. Champions who know the challenges and generate excitement about the possibilities. Tireless against pushing back and tireless in pushing forward. To stop — and, hopefully, reverse — the increasing disparities that rural areas face, people involved in healthcare, including researchers, funders, and policymakers, must better appreciate the factors affecting the rural healthcare system. One step forward is to create sustainable standardization of processes and administrative support. By doing this, positive patient outcomes will increase, and rural healthcare facilities will benefit.

Sources
Cross SH, Califf RM, Warraich HJ. Rural-Urban Disparity in Mortality in the US From 1999 to 2019. JAMA. 2021;325(22):2312–2314. doi:10.1001/jama.2021.5334

What is the Acuity Index? The Quick and Clean Guide to the Patient Assessment Score for Interfacility Transfer

A patient assessment score helps health care teams allocate resources and determine the appropriate care a person should receive. Until now, there has been no standardized methodology to determine the vital, transfer-specific elements of a person’s condition as necessary to how they will be moved between facilities, using which modalities and resources.

Founded in Decades of Real-World Expertise

The Acuity Index was created by Martin Sellberg, M.D., FACEP, and contributed to by Richard Watson, M.D. It’s based on their combined decades of emergency medicine and medical transport experience in various emergency departments, from rural and frontier settings to major urban trauma centers.

Drs. Sellberg and Watson recognized a need to assess the unique variables considered during adult interfacility transfers. When a person is removed from the resource-rich environment of a hospital or similar setting, there must be a commonly understood measurement to determine their current and continued stability, the interventions and monitoring skills needed to maintain that stability, and their risk of deterioration once they leave the hospital and begin their journey to definitive care.

The Acuity Index helps answer questions like this: What do providers consider when determining the most appropriate mode of transport for a patient who needs a neurological intervention 90 miles away versus a stable orthopedic injured patient at the same facility when their receiving hospital is 200 miles away?

8 Questions. 3 Key Areas. Invaluable Information.

The Acuity Index asks healthcare professionals to answer eight questions. The questions consider clinical workload, risk, a prognostic perspective of the patient, and in general, the level of care needed based on the severity of illness, all critical components of moving the patient between controlled and uncontrolled environments.

These eight questions are broken into three parts that determine patient level of care, support, and risk of deterioration.

1. Level of care and monitoring the patient will receive at the destination facility

2. Physiological support or intervention needed to maintain patient stability

3. Risk of deterioration during transfer

The information gathered under these categories is weighted and assigns a numerical value to the person being assessed. The value reflects the patient’s illness level or severity to help determine the level of care needed in the transfer process, such as crew capability, recommended mode, and other factors — information that was previously not possible to standardize. This Acuity Score stratifies patients into groupings to aid quality departments and enhance reporting processes.

The Acuity Index Creates a Common Language for Interfacility Transfer Assessment

The Acuity Index creates a common language for transfer assessment. Instead of increasing the saturation of assessment scores, however, the Acuity Index fills a critical need: The value of the Acuity Index is specific to patient movement, an assessment that previously did not exist.

The decisions made regarding destination and timing, and mode and level of care, in patient movement have far-reaching effects on financial and clinical outcomes. Healthcare cannot afford transport decision-making based on random or incomplete information, and the strategy, “this is the way we’ve always done it,” makes little business sense. Instead, interfacility transport should be guided by an organized assessment and decision process and data that can be shared through the system to assist in further dialogue to identify and solve local challenges collaboratively. The Acuity Index explicitly scores a person’s condition as appropriate for critical transport points between the sender, EMS, and the receiver. It has a specific use and value applied directly to patient movement.

The Acuity Index also creates significant value in enabling patient stratification for transfer reporting and quality metrics. The Acuity Score enables quality managers to evaluate resource utilization across patient types, DRGs, and Acuity Scores. Furthermore, the Acuity Score can be used for reimbursement justification and Time Critical Diagnosis assessment and reporting.

Please contact us here to learn more about the Acuity Index and Mission Control.

Mission Control Feature Alert: New Mission Creation Interface

Mission Control is excited to announce a new interface for mission creation that will further simplify the way you create transfers in Mission Control. The new look provides:

Improved design and fewer overall clicks.
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A progress bar to show how far along the process you are.
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Map view for selecting your preferred destination options or a picklist option.

If assistance is needed in locating a destination, there is a new method for providing additional information.
Destination Selection.gif

You also have the ability to edit data from the destination selection screen without restarting the workflow.

A Mission Summary screen that allows for a selection of a “preferred mode” selection to indicate a desired mode of transport. Users can review all Mission information from this summary prior to submission.

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These changes were made improve the overall workflow and save you — and the patients you help care for — valuable time. We hope these changes make using Mission Control more efficient and user-friendly.

The new designs will be “live” on MissionControlTransfer.com starting Tuesday 6/15. We’ve updated our training materials for you to familiarize yourself with the new Mission Interface prior to deployment on the 15th.

Training materials on the new designs are available under “Courses” from the gear icon inside Mission Control. They can also be accessed directly by this link.

We have a number of new features and functionality in the works that we are excited to share in the weeks ahead. Please let us know if there are items that improve the utility of Mission Control for you and your patients.

Questions or Comments? Contact Us.

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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!

Aubrey Arnold MS, BSN/RN

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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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