Transfer center innovations protect hospital bottom line
Transfer center innovations protect hospital bottom line
Care, customer service enhanced
The defining protocol at a hospital transfer center is clear: If a patient urgently needs care, and your facility is the best place for him or her to receive that care, you bring the person in, provide the care, and talk later about how it's going to be funded.
That said, the transfer center must have appropriate policies and procedures in place in order to be a reasonable steward of the health care organization's resources, says Sue Altman, president of Phoenix-based Call Center Consulting Network.
"How many patients do you take from an outlying hospital who really could have been treated where they were?"
The hospital transfer center a type of call center has been gradually increasing in popularity over the past five years, says Altman, who ran call centers in the late 1980s and early '90s and later worked for call center software vendors. Her business now is "vendor neutral," offering strategic planning and positioning, among other services, for call centers.
"As the industry has different needs," she notes, "what the call center needs varies."
Centralization premise of transfer center
The premise of the transfer center, as with other call centers, is centralization, Altman says, and it typically handles four types of transfers:
- emergency department to emergency department;
- ED to inpatient;
- inpatient to inpatient;
- direct admit from physician's office or clinic.
Without a centralized transfer center at a receiving hospital, there might be five or six places for the sender physician, rural hospital, or urban hospital without capacity to call, she says. Those include such areas as reservations, patient placement, the ED, and the bed coordinator, or health manager, Altman adds.
Rather than make those five or six calls, she continues, the sending facility "would love to have that central number" to make the necessary arrangements, sometimes described by the phrase "one call that's all," which Altman likes to use.
Call center potential not always realized
Think creatively, consultant advises
While call centers are typically considered overhead, says Sue Altman, president of the Phoenix, AZ-based Call Center Consulting Network, "every call you handle is facilitating more than just someone coming in for a lab test. These are big-dollar patients and there is a very satisfying return on investment."
Having an automated, centralized, dedicated system in place can increase the number of patients being brought in efficiently, Altman adds, and call center management will be able to say, "We used to bring in this many patients, but now we bring in this many."
Don't discount benefits of call centers
Leaders at some hospitals and health systems fail to realize the potential benefits of call centers in general, she points out. "There is a hesitancy in health care to identify work or important business that comes in through the telephone as [constituting] a need for a call center."
People have in mind what a call center is staff on the telephone or on PCs working on software and may fail to think creatively about ways in which the concept can be applied, she suggests.
There should be an overall vision for hospitals and physicians and consideration of whether any time an inbound call comes in, they are managing it well, Altman says. "They should be thinking about how people communicate inside the organization.
"You might have a marketing call center, a triage line, scheduling, and then there is direct admit and ED-to-ED transfer," she adds. "All make impressions on your audience. Are you managing that?"
Customers receive inconsistent messages when a caller interrupts someone in the middle of a task who is not expecting a call, Altman notes. "That [caller] gets whatever mood that staff member is in. Joe Employee doesn't think, 'Every call is my opportunity to make a good impression.'"
Patients who reach ED, front desk, or bed board staff "kind of catch them in the middle of whatever crisis they're in," she says.
Employees at a dedicated call center, however, do tend to think in terms of making a good impression, Altman adds. "There is a purposeful standard and an organized sequence of questions.
"If people are thinking of getting a transfer line up and running, but they're thinking of it in a vacuum, they may miss the fact that there is already a telephone management system in place that can provide good statistics," she says. "Sometimes it's just a matter of adding a couple of more seats and tapping in to a licensure that is already in place.
"These software products are really robust," Altman adds, "and most [organizations] don't use all of what is in the software. Most [vendors] recognize that transfer is an important function and have that built in. Marketing referral software almost always has a hospital transfer module."
An area that is just doing physician referral and appointments, though, may see the transfer piece as something another department would do, she notes.
Altman says she has worked with several health care organizations that have "co-located," meaning different functions share a location to make better use of infrastructure such as a good telephone system with more features.
"You can have a unit of people located in the same room [with another group] but doing a different service," she notes. "We're so used to having our silo system in health care that we can't think past that."
Another idea is to create a call center career path, Altman says. As someone in an entry-level position, such as hospital operator, becomes proficient on the phone and learns how to schedule appointments, she adds, that individual could move into a call center job.
"You need to know a lot about how a hospital works to do a good job [in a call center]," Altman notes.
The receiving facility, meanwhile, is tired of taking multiple calls to get one patient in, which interrupts a lot of caregivers who can't facilitate the whole process, Altman says. The hospital transfer center, on the other hand, sets up the entire transfer, she adds, "which is a good, efficient use of resources and really great customer service."
The flip side of this apparent win-win situation, of course, is that hospitals sometimes send patients whose care they know they won't get paid for a practice commonly known as "patient dumping" and receiving facilities that don't have a good system for managing transfers are more at risk of getting dumped on, Altman notes.
Patient dumping typically occurs when someone is in the hospital and his or her DRG (diagnosis-related group) payment runs out or when the person is simply uninsured with no other funding source, she says.
"If [the sender] makes it sound like an emergency, and if you don't have a good process to ask some important questions and find out if there is true need," Altman continues, "you will get patients who should have stayed where they were."
A hospital qualified to care for a higher level of acuity by definition "has a heck of a hard time saying no," she points out. "There is a fine line, and nobody wants to be on the other end of an EMTALA violation."
A good transfer center = extra protection
A transfer center with the proper tools and procedures in place, Altman says, can provide a "layer of protection so you're not just bringing them all in and bottoming out your financial situation."
Elements that can comprise that layer of protection, she suggests, include the following:
"The nice thing about transfer centers and something I make sure they always have is the recording of calls," Altman says. "If [the sender] says, 'The patient needs this and we don't do it,' and you find out later the patient was fine where he was or that the condition was exaggerated, you have something to take to the powers that be."
"Scripting helps transfer staff not only ask the right questions but discreetly document what is said," she notes. "One thing that is very good is that you can build some specialty-specific questions that really help the transfer process."
To make the best use of the sending facility's time, if there is, for example, a trauma case, staff at the receiving hospital can click on "trauma" and bring up several additional pieces of information to prompt follow-up questions, Altman says. (See script, this page.)
Script to streamline transfer process
Having specialty-specific scripting as part of a transfer center's call management system makes use of the physician time more efficient and helps ensure that patients receive treatment as quickly as possible, says Sue Altman, president of the Call Center Consulting Network in Phoenix.
In the event of a transfer involving a neurosurgery case, for example, the transfer center employee might ask:
This kind of scripting can provide the receiving hospital's physician "the exact four or five things he wants to know before he takes the call from the referring physician," she adds. "It adds customer service because it makes for a more efficient call, but it also allows you to [quickly] get right down to the core. With a lot of patients, the situation is time-sensitive."
Decisions must be made, Altman says, on whether an ambulance or LifeFlight will be sent, and what other care-related preparations are necessary.
Regarding back-end customer service, she notes, if a system is in place to prompt for each next step such as letting the sending facility know that the patient arrived safely the call center representative doesn't have to think later, "Did I remember to call them?"
There are protocols that can be built into the call management system, for example, that allow a user to click on a specialty and bring up the name of the physician who is on call at that moment, Altman points out. With some systems, she adds, that individual can be paged automatically.
"If you're truly trying to improve your process, what's really important is to see how long each step of the process takes," she says. "[Call management software] will time each action. Staff always have a gut feeling of where things break down but now you'll have the data."
Getting an accurate measure of what kind of demand is out there is another useful feature of call management software, Altman explains. "You will know exactly what services you get calls for, and what time of day.
"There are certain times of day that certain calls come in," she says. "Direct admits all seem to logjam around 3 or 4 in the afternoon."
Another thing that will become obvious is where and when your competitors do and don't have coverage, Altman notes. "Say hospital one has an orthopedic hand specialist, and maybe the coverage is between 9 a.m. and 6 p.m."
Having that information helps your hospital know in a timely manner whether to try to send a patient whose hand has been mangled in a machine to that hospital or to go directly to another option, she says.
In many cases, Altman adds, "what you do in the first hour or first four hours is vital."
It's crucial for the transfer center staff to have a close relationship with the person who oversees patient placement, who might be the house manager or the bed coordinator or the nurse in charge of throughput, Altman says.
"If a patient comes through the ED and based on his condition needs to go to the intensive care unit," she continues, "the transfer center has to be intimately aware of bed capacity, bed availability, and any department that might be on bypass."
Ideally, the transfer center has a view of all those systems at all times, Altman adds. "If you have the best surgeon in the country, but he is in a six-hour surgery, you need to know if he has backup, if there is a resident who can get [a procedure] started. It's traffic control."
The busiest time for a transfer center is between 10 a.m. and 9 p.m., she notes, "but you still have to go 24 hours."
[Editor's note: Sue Altman may be reached at [email protected].]The defining protocol at a hospital transfer center is clear: If a patient urgently needs care, and your facility is the best place for him or her to receive that care, you bring the person in, provide the care, and talk later about how it's going to be funded.
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