Located halfway between Wichita and Kansas City, Newman Regional Health (NRH) is a nonprofit, 25-bed critical access hospital owned by the citizens of Lyon County, Kan. Despite its small size, for the past five years NRH has ranked among Becker Hospital Review’s top critical access hospitals in the nation. The hospital’s 10-bed acute inpatient medical rehabilitation unit offers patients the opportunity to recover from serious illness or injury closer to home, following treatment at NRH or neighboring facilities. In 2019, NRH opened a 19-bed emergency room with an additional 14 beds for observation and express care.
The challenge: Facilitating rapid transfers for critical patients
Like many rural hospitals, NRH had long been dependent on the only Emergency Medical Services (EMS) provider in the county for its ground transport needs. While this provider was a valued partner, its resources were frequently stretched thin across a wide jurisdiction, and it was not always able to meet the hospital’s needs.
To bridge the gap, NRH turned to Motient, a company that equips hospitals, accountable care organizations (ACOs) and healthcare networks with the tools and data required to ensure quality care in patient transfers.
In August 2019, the NRH hospitalist team implemented a software application from Motient to streamline the transport decision and request workflow via acuity scoring and a comprehensive logistics and communication dashboard. Initially, NRH used the software primarily to find alternative ground transport for its emergency department patients. The team was just beginning to deploy the platform’s web application and analytics tools when the 2020 winter surge of COVID-19 hit.
Bed capacity dropped precipitously across Kansas, and NRH struggled to find receiving facilities for its transfers, especially for acute COVID-19 patients. Physicians would spend hours on the phone, calling more than half a dozen facilities in search of a bed. Like many of the larger facilities nearby, NRH was soon operating at 110% of its pre-pandemic inpatient acute care capacity. The hospital needed additional help managing the time-consuming patient transfer process.
The solution: Streamlining the patient transfer process
Julia Pyle, RN, MSN, chief operating officer and chief nursing officer at NRH, proposed expanding NRH’s use of the software to find available beds. The hospital’s clinical resource nurses began using the web application to find open beds for time-critical patients, lifting the communications burden off frontline workers. “When beds across all spectrums of care became tight, we started using the platform to find beds,” said Alana Longwell, DO, chief medical officer at NRH. “Now, we use [it] for more than 90% of our transfer patients.”
Initially, many tertiary facilities in the region were reluctant to respond to messages from Motient’s 24/7 communications team inquiring about bed availability. These hospitals were not yet familiar with the software’s role in the patient transport process, and hesitated to share information with anyone other than a physician or a referring facility.
When the Delta surge hit in summer 2021, NRH decided to regroup and organize a more formal rollout of the platform that included educating potential receiving facilities about the process. Along with NRH’s clinical resource nurses, Dr. Longwell and her inpatient team now had their own logins for the platform, and were soon relying on the system to facilitate transfer coordination.
NRH quickly taught its physicians and nurses how to log in to the application and enter the necessary patient information for a transfer request. “Education is key. At NRH, any practitioner in the hospital can enter a mission into the platform,” said Dr. Longwell. “We found that the process works much more efficiently when your transfers don’t have to go through a gatekeeper.”
Instead of spending hours on the phone searching for beds, NRH’s clinicians spend two to three minutes to enter the patient’s clinical data and input a transfer on the platform. The software takes it from there, notifying the clinician when an open bed is located.
“The nice thing is that if I’ve stepped away, the lines of communication are still open. Before, if we missed a return phone call because we were in a dead zone somewhere, we may have lost the bed,” said Dr. Longwell. “Now, if they’re not getting a response, the vendor will call a clinical resource nurse and keep working down our communication tree until they reach someone. We can input a transfer and go on about our daily activities without worrying.”
Before using the software, NRH’s clinicians would sometimes speak with receiving physicians who had no idea whether their facility had open beds. As the application communicates directly with receiving facilities’ bed coordinators, data is always current. While a few ER physicians still get on the phone to find beds, NRH plans on educating these holdouts about how easy the new platform is to use — and how much time it can save them.
“Early on, I was filling in for our main hospitalist for a week, and we had a patient who needed to transfer for a soft bleed, which we don’t have the technology to manage here,” said Dr. Longwell. “That same week, the entire State of New Mexico was out of ICU beds. Without the platform, there was no way I could have made those calls to get that patient to a receiving facility in time.”
Improving performance with robust patient transfer analytics
Once the pandemic is under control, NRH expects the primary value of its patient transport platform will lie in its data analytics capabilities. As a rural hospital, NRH has only one person on staff who performs all its data abstracting. With the platform, NRH will be able to dive deep into its transfer data to uncover areas of opportunity and ensure the appropriate patients are being transferred to the appropriate facilities by the correct means of transportation.
“The relationship we’ve been able to build with Motient is truly fundamental to the results we’ve seen,” said Dr. Longwell. “We let them know what features would be helpful for our facility, and they listen to our input and make changes when necessary.”
In the past year, NRH was forced to close its 24-hour ST-segment elevation myocardial infarction (STEMI) program due to resource constraints. Dr. Longwell anticipates using Motient’s application to track outcomes and ensure its transferred STEMI and stroke patients are receiving quality care at appropriate receiving centers. “We’ll be able to slice and dice our data around time-critical diagnoses to help us increase efficiency and improve our transport processes,” said Dr. Longwell.
Even when the pandemic eases, staffing shortages will not be resolved anytime soon. The team at NRH is encouraged by growing adoption of the software across the state. In the past year, 115 Kansan hospitals used the solution to coordinate transport services for more than 5,100 interfacility transfers across the region.
Buoyed by this success, the Kansas Department of Health and Environment recently expanded its partnership with Motient to arrange patient transportation, source destination facilities, and provide analytics to improve the patient transfer process. “In terms of preventative healthcare and resource redeployment, the wealth of data that will come out of a statewide program like this will be invaluable in a few years,” said Dr. Longwell.
Statewide data will help Kansas assess transfer activity by area and specialty, determining key information such as where the highest volume of time-critical diagnoses originate, and which communities need additional resources. NRH anticipates that this retrospective analysis will help hospitals across the state work together to improve patient outcomes.
“Even during normal times, we’re always going to have to transfer some patients, as we don’t have the capacity to do neurocritical care or perform every kind of specialty surgery,” said Dr. Longwell. “For rural hospitals, having a partner who helps us find beds for our critical patients is instrumental, because it frees up time for our clinicians to be at the bedside.”