The following is a guest article by Chris Gallagher, MD, CEO at Access TeleCare

I still remember treating my first hospital patient with telemedicine like it was yesterday. It was 2013, and we had recently started building what would become the first 100% virtual ICU in Texas when a patient came into the ER presenting with septic shock. She was very sick; every minute mattered. In the past, the hospital would have had to transfer a patient like this by ambulance or helicopter to the nearest hospital with a team that could care for her – about 60 miles to Dallas. Since we had the new tele-ICU in place, we got right to work assessing her, making it possible to begin treatment right away. The patient recovered and I realized we could use technology to provide high-quality care and avoid unnecessary transfers for patients in hospitals across the country. 

Despite that innovative approach at a rural hospital more than 10 years ago, approximately 1.5 million patients are still transferred between acute care hospitals in the U.S. each year. Without specialists, emergency departments and hospitalists may feel that transferring a patient with complex care needs is the best option. While this always makes sense if the patient needs a procedure that cannot be provided by the referring hospital, it often could be avoided if the hospital had a specialty provider on staff. 

For some hospitals, there may not be enough consistent patient volume to justify a full-time MD specialist, so they go without and transfer the patients who need specialized care to a larger facility. 

But studies have shown that outbound transfers correlate with higher costs, longer lengths of stay (LOS), and worse outcomes for patients. In one study, inter-hospital transfer patients experienced a 60% longer average LOS and a higher proportion of time spent in the ICU than patients admitted through the ED. Those patients also had a higher risk of in-hospital death.  

Beyond the numbers, a transfer away from a patient’s local hospital means they are further from their community, family, and friends, who may not be able to travel to see them. 

When it comes to non-procedural care in community hospitals, we should consider the use of inter-hospital transfers a failure. Tech-enabled clinical services are a proven model to bring specialty care access; a fractional model where a single specialist or pod of specialists can cover a large geography with multiple hospitals without being full-time in any of them helps level the balance of affordability and access.

Today’s Challenges Require Innovative Solutions 

Each year, more than 139.8 million Americans visit an emergency room. Those visits include an increase in higher-acuity patients and individuals visiting the emergency department for acute mental health emergencies. At the same time, the Association of American Medical Colleges projects a physician shortage of up to 86,000 physicians by 2036. And on the operations side, hospitals face growing budgetary challenges, with reimbursements not keeping up with expenses. 

These mounting challenges require innovative solutions and strategies that will reduce the reliance on risky and harmful practices, such as inter-hospital transfers, enable hospitals and health systems to deliver high-quality care to all patients, and increase revenue. 

With advances in technology and evolving care delivery models, the opportunities to address these challenges efficiently, while prioritizing quality of care, are vast (and growing). For example:

• Acute specialty telemedicine provides timely access to specialty care, reduces transfers, and improves operational efficiency
• AI scribe technology reduces the amount of time doctors spend documenting, allows them to spend more time on patient care, and reduces burnout
• Virtual nursing reduces burnout and turnover of on-site nurses, improves fall detection and prevention, and reduces costs

Hospitals that Lean into Innovative Solutions are Improving Patient Care, Reducing Transfers, and Driving New Sources of Revenue 

Six hospitals in the South – part of the same health system – were having to transfer a high number of neurology patients to other facilities because they did not have specialists on staff who could deliver the level of care needed. As a result, they experienced lost revenue and poor patient satisfaction. When they introduced a teleNeurohospitalist program for inpatient neurology care, they were able to retain higher-complexity neurology patients and reduce transfers by 60%.

A Texas-based hospital introduced telePulmonary and Critical Care services that enabled them to manage patients with a 24/7 virtual specialist team. The acute specialty program drove a 30% increase in ICU volume and reduced transfers by 69%.

In North Carolina, a 476-bed acute care hospital reduced LOS for behavioral health patients by 70% and reduced the amount of Code Purple hours (ED Ambulance Diversion) from 1,700 annually to just 148. 

Asking the Right Questions Can Help Determine if Your Hospital is Relying Too Heavily on Ineffective Models of Care 

There are many viable solutions that address the aforementioned challenges faced by today’s hospitals and health systems, but just like patient care, one size does not fit all. That’s why it’s important to start by asking the right questions. The resulting answers can help determine the most effective path forward based on an organization’s unique challenges. 

• How many patients does your organization transfer each year? 
• What are those patients being transferred for (e.g., neurology, cardiology)? 
• If we had access to a specialist provider that addresses the reasons for those transfers, could we keep and treat those patients? 
• How much revenue would that help us retain?
• What specialty acute care do we offer?
  • Do we need to expand those services in order to serve our community’s evolving needs?
  • Would that care need to be part-time, full-time? 
• What would the impact on our patient experience be if we could allow more patients to get the care they need close to home, without having to transfer?

I am hearing regularly from hospitals and health systems – especially in rural communities – that cannot keep or find specialty providers to provide in-person care. As a result, the people living in their communities are forced to go without necessary care, drive more than 45 minutes to get the care they need, or be transferred to a hospital far away from their home and loved ones. We simply cannot be resigned to that reality. This is an incredible moment where existing technology can actually address the significant challenges facing our health system. It’s time we assess those challenges, ask the right questions, collect accurate data, and implement the kinds of solutions that will allow us to keep doing the work we got into healthcare to do: deliver quality care to every patient.