In Patient Movement, Closer Isn’t Always Better

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When a patient calls an ambulance with a condition such as a stroke, heart attack, or traumatic injury, Emergency Medical Services (EMS) protocols ensure emergent transport to the most appropriate facility for immediate treatment. However, this often isn’t the end of the patient journey. Once the patient’s condition stabilizes, they may need to be transferred to yet another facility for any number of reasons, including clinical or surgical specialization, specific testing requirements, and lack of capacity.

Historically, there has been no standardized methodology to determine where and how patients are moved in these scenarios. The decision is largely based on the experience of physicians, nurses, and ancillary staff, who rely on their accumulated clinical wisdom in selecting the next step in a patient’s care. Clinical experience is invaluable in the transfer process, but relying on experience alone can lead to oversight, risk, and unbalanced prioritization.

For example, some caregivers may simply opt for the closest available facility based on convenience and proximity—two factors that aren’t necessarily foremost in saving lives. Several other factors that must be considered to ensure optimal transfer and patient outcomes. Having a standardized communication framework that uses objective language and centers on patient acuity can turn transfer assessment into a repeatable, organized process that can be applied to every patient, reducing variability, guesswork, and risk.

An Acuity Index for standardized transfer decision-making

In a previous blog, we outlined the value of Motient’s Acuity Index, which provides a standard protocol for patient transfer assessment. The Index scores a person’s condition based on answers to eight questions that consider the current clinical workload, the present risks, a prognostic perspective of the patient, and the level of care the patient will need based on the severity of their illness. Understanding the patient’s acuity level helps providers match the transfer patient with an optimal receiving facility that can provide the necessary care.

The information gathered by the Acuity Index is weighted, and the result helps providers determine the level of care needed in the transfer process, such as crew capabilities and the recommended transport mode. Key measures calculated include the current stability of the patient, the interventions and monitoring needed to maintain that stability, and the patient’s risk of deterioration once they leave the hospital and begin their journey to definitive care. The final Acuity Score stratifies patients into groupings to aid quality departments and enhance reporting processes.

The assessment of clinical deterioration is critical in the transfer process, as a higher pre-transfer risk score predicts the probability of clinical deterioration. According to a 2020 study, the incidence of clinical decline in the interfacility transfer of critically ill and injured patients was 28.69%. The types of illnesses with the highest probability of clinical deterioration are those involving circulatory, respiratory, and neurological systems (e.g., arrhythmias, chest pain, traumatic head injury, etc.). Having a standard protocol in place to evaluate the patient’s risk of deterioration—and to adjust transfer mode and crew capabilities accordingly—is a crucial factor in ensuring the best possible outcomes.

A common language for patient movement and bed management

The patient’s acuity score functions as the baseline for transfer decisions, allowing sending hospitals to determine if a proposed receiving hospital has the resources necessary to adequately meet the patient’s needs while prioritizing patient movement based on time sensitivity. Receiving centers can also survey incoming patients to assist in their internal bed management.

When clinicians have the common language of acuity at their disposal, the patient’s score functions as shorthand, immediately conveying the difference between patients. This utility is essential, as a score can quickly communicate the core condition of the patient without the listener having to parse the details in that moment. Clinicians who are well-versed in the acuity scale will immediately understand what the score represents and can act accordingly.

Appropriate initial placement of a transferred patient can save valuable clinical time. Acuity scores can also be used to help clinicians guide bed placement decisions. For example, a telemetry bed request for a patient with a high acuity score can trigger a pre-arrival screening to clarify if a patient with high care needs should be placed on an intermediate unit.

The proximity of a destination facility is just one factor in a potential transfer decision and one that isn’t necessarily the most important. Care capabilities, patient acuity, risk of deterioration, transportation mode, and timing all impact the ultimate success of a transfer. The decision to transfer a patient cannot be made with incomplete, random, or potentially biased information. Instead, transfers must be guided by an organized assessment and decision process. This data should also be shared among all parties in the transfer process to facilitate ongoing dialogue and collaborative problem-solving.

Tools like Motient’s Mission Control can help providers streamline transfer decisions by enabling patient acuity tracking and the monitoring of hospital and medical transport logistics from a single source. Patient condition changes, ETA updates, routing changes, real-time maps, utilization, and more can all be tracked via the Mission Control dashboard to ensure clinically informed, value-based decision making. Learn more.

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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!

DJ Craighead, RN

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