Centralized process facilitates transfers

RNs get information needed for clinical decisions

By centralizing the patient transfer process, Baylor Health Care System, with headquarters in Dallas, has made it easier for patient to transfer from one hospital to another and facilitates communication between clinicians.

"The role of the transfer center is to facilitate the entire transfer process and obtain adequate clinical information for the Baylor hospitals to make an informed decision about the patient's needs," says Elisa Ayers, LMSW, CCM, director of care coordination support at Baylor Health Care System's Patient Transfer Center.

Before the health system opened the Patient Transfer Center in January 2009, community hospitals complained that it was difficult to get patients into the Baylor Health Care System because they had to call hospitals one at a time to find out if there were available beds. "We felt like we were losing business by making the process cumbersome and decided to set up one central process so community hospitals could more easily transfer their patients into Baylor hospitals," Ayers says.

The center is open 24-hours a day, seven days a week and has an all RN-staff, many of whom have been in nursing for 20 years or more. "This is a good opportunity for nurses who are looking for another way to use their clinical knowledge. The more seasoned nurses have the clinical knowledge and experience to decipher patient needs and understand what information is needed so informed clinical decisions can be made," Ayers says.

Initially, the staff was a mix of nurses and non-clinical staff who answered calls and obtained demographic information on the patients before transferring them to a nurse. "After about a year, we determined that this was not an effective process. The callers often began by rattling off clinical information that the non-clinical staff had difficulty understanding or prioritizing," she says.

During Phase 1, the center focused on inpatient to inpatient transfers. In Phase 2, which began in December 2011, the center began facilitating transfers from emergency department to emergency department. "Emergency department to emergency department transfers involves complying with the Emergency Medical Treatment and Labor Act (EMTALA) and the Texas Transfer Law requirements. There are some time constraints and we had to ensure we were good at our core processes before beginning the emergency department transfers," she says.

When hospital representatives call the center, they choose between three prompts: inpatient to inpatient transfer, emergency department to emergency department transfer, and physicians returning a call. The calls are prioritized according to which option is chosen. All phone calls are recorded.

For inpatient-to-inpatient transfers, the nurses start the call by obtaining patient demographics and the reason for the transfer. Then they ask if there is a preference of hospitals or physicians to follow the patients after transfer.

The nurse calls the hospital of choice and confirms there is a bed available and secures an admitting or consulting physician. Then the physician from the sending hospital talks to the physician in the receiving hospital. Once the physician and bed are secured, the transfer center nurse facilitates an RN-to-RN report between the sending and receiving nurses assigned to patients.

If the caller doesn't indicate a preference for a Baylor hospital or physician, the nurse selects a hospital based on location and service line, then calls to find out bed availability and talks to the on call physician for the specialty the patient needs. The transfer center uses the same process when patients are transferred from one Baylor hospital to another Baylor Hospital. About 75% of the transfers are external community transfers and 25% are transfers within the Baylor system.

Emergency department to emergency department transfers get top priority with a goal of turning around the transfer in 30 minutes. When the initial call comes in the nurse calls the receiving hospital to make sure there is bed capacity, facilitates the communication of clinical information and gets approval for the transfer.

All hospitals in the Baylor system share a bed tracking platform which allows the Transfer Center nurses to quickly assess bed capacity across the system. The transfer center uses data from the transfer software to generate reports for the hospitals showing the number of transfer requests, turnaround time from the time the call is initiated until the patient is placed, and information about patient diagnoses.

"To date, the Patient Transfer Center has placed more than 7,000 patients from the Dallas/Ft.Worth/Metroplex into the Baylor Health Care System. The centralization of this service has provided ease of access in transferring patients into the Baylor Health Care System, and has increased satisfaction among sending facilities and both referring and receiving doctors," Ayers says.


For more information contact:

  • Elisa Ayers, LMSW, CCM, Director of Care Coordination Support at Baylor Healthcare System's Patient Transfer Center, Dallas. Email: ElisaA@BaylorHealth.edu.