Background:
Capacity constraints are a common problem at many academic institutions. At Duke University Hospital (DUH) , capacity constraints continue to result in critical bed shortages. Our affiliated hospital, Duke Regional Hospital (DRH) which is less than 5 miles away, has the capacity and capability to provide care to these general medicine patients. Shifting general medicine patients to DRH may alleviate some of this overcrowding.
Purpose:
In order to effectively manage bed capacity in Durham County, Duke Health System has implemented a protocol to admit appropriate general medicine patients from the Duke ED directly to DRH medical floors. This shift of patients improves our ability to bring patients to DUH who require tertiary care while assisting DRH to meet its growth targets.
Description:
A multidisciplinary group consisting of representatives from the DUH emergency department, DRH Hospital Medicine, Transfer Center Leadership, Duke Hospital Medicine was formed to discuss past experiences with the process and to identify opportunities for improvement. Using DMAIC methodology, a new process was developed within this group. The problems and inefficiencies in the existing process were defined. Scripting by the ER providers was identified as the earliest opportunity for improvement. Consolidation and improvement of the documentation to meet the legal requirements for a transfer was also identified as an opportunity for improvement. Finally making the process more efficient for providers and the patient was also cited as an area for improvement. The committee refined the process and a new policy and process was developed and launched on June 15, 2015. Since implementation, there have been a number of PDSA cycles to refine the process. After an implementation period, we conducted a survey to assess future areas of opportunity in our transfer process.
Conclusions:
As a result of the process improvement, a record number of interfacility transfers occurred from DUH ED to DRH this past fiscal year. Compared to the prior year, we had an increase of nearly 400 %. More importantly we have been able to conduct these transfers safely and allow expedient care for these patients with good outcomes such as short length of stays and low readmission rates. There have been opportunities for improvement in the efficiency of these transfers through our ED as the average time for transfer is 5.8 hours.
In order to identify opportunities for improvement in our next cycle of improvement, survey results from providers involved in the transfer process were analyzed. There were 65 respondents with good representation of ED providers and hospitalists from the sending hospital and receiving hospital. ED providers had higher satisfaction scores with the process than DRH hospitalists and DUH hospitalists. Opportunities for improvement were identified in wait times for ambulances, ownership of patient care during the waiting period, and lack of clear ownership for success of the project.
Bed Capacity management remains a challenge at many academic institutions. As hospitals consolidate, developing a process to facilitate transfers from the one ED to an affiliated hospital can be done safely to allow additional bed capacity. Opportunities remain to make the process more efficient in order to promote greater usage and physician satisfaction in the future.
