What Is the Burden of These Patients on EDs and Ambulance Providers?
The ED volumes seen in the U.S. in 2023 will be reported at around 160 million patients. At a 3.2 percent transfer rate, that is about 5.1 million patients being transferred in a year, or almost 14,000 patients a day. That patient movement stresses all types of hospitals and requires consideration of EMTALA requirements with each one. These tallies do not include freestanding EDs, which have an estimated transfer rate of about 7 percent.
This only represents ED transfers. Some hospitals also must transfer patients out of inpatient units when patient needs cannot be managed in the original hospital. This results in a significant caseload for ambulance transport services that provide the bulk of patient movement.
Moving Toward Solutions to Flow of Admitted and Transfer Patients
The management of admitted patients for prolonged periods of time is a current problem for all EDs. The issue of inpatient boarding compromising ED operations has been widely reported.3 The additional lengthy ED stays for transfer patients are equally resource-intense for emergency physicians and especially emergency nurses. Some hospital systems have developed transfer centers or flow centers, which attempt to coordinate patient movement to the best site of care within the system. But for independent, and particularly smaller and rural hospitals, the process of finding an accepting hospital for patients needing transfer is a huge burden that involves placing one phone call or digital request at a time. Once a patient is accepted somewhere, the facility must then begin the process of finding a transport resource, coordinating the right time of transfer with the receiving facility, and completing the required documentation.
This points to a need for centers that may specialize in regional patient movement, to include all hospitals and systems. In regions like San Antonio, Texas, this innovation has taken place already and serves needs across a large geographic region and many patient types (https://www.strac.org/). The state of Georgia has developed and funded a coordinating center for patient movement and EMS communications on hospital capabilities (https://georgiarcc.org/). These coordinating centers have been advantageous when patient surges occurred, such as those experienced during the most stressful days of the COVID-19 pandemic.
Emergency physicians have ongoing leadership opportunities in changing and regionalizing the acute care delivery system. The need to serve ED patients who must be transferred for ongoing care is an important management priority that was recognized widely during the pandemic and will continue into the future.
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