Getting in front of long wait times in emergency departments | Viewpoint

Emergency departments are often the point of entry to critical life-saving care, but they can become bottlenecks of patients presenting with a variety of needs—from dire emergencies to behavioral health crises, to minor illnesses and injuries, to complex conditions that have not been diagnosed.

Mercy Health-Springfield Regional Medical Center in Ohio partnered with a patient transfer service to reduce wait times in the emergency department. (Image credit: Spiroview Inc. - stock.adobe.com)

The national landscape of emergency department visits is getting longer due in large part to prolonged wait times and growing challenges such as staffing levels, the wide range of acuity and bed capacity to name a few.

As the only full-service hospital serving residents of Clark County in Ohio, Mercy Health — Springfield Regional Medical Center faced notable challenges on the behavioral health front. Realizing that it did not have the resources to optimally address timely transfers of patients in crisis, hospital leaders turned to a patient transfer service to devise a strategy that would centralize transfer processes, improve internal communication and help patients get the most appropriate care in a timely manner.

Early data demonstrates strong efficacy of the collaboration. ED length of stay for behavioral health patients dropped 64%, speeding time to treatment and improving safety for patients and staff. The new process also resulted in a 27% reduction in average phone calls from the centralized transfer center to the ED and a 50-second per-call reduction in talk time during the calls.

The ED transfer conundrum

ED crowding is a significant challenge in today’s hospitals, putting patients at risk and negatively impacting care access.

Consider what can happen when multiple patients needing a cardiac placement present to an ED in a small rural community on the same night. This places significant strains on limited nursing staff, who must navigate outreach to on-call physicians and the burdensome process of finding a placement in the closest hospital, which may be several hours away.

Pressures on staff to meet these patients’ needs may last for hours or days, delaying care and exacerbating the patient’s condition. Notably, research points to unacceptable and life-threatening delays in transferring ST-elevation myocardial infarction (STEMI) patients and the need for a more rapid and reliable system.

Behavioral health patients in particular—especially those experiencing suicidal ideation—require specific expertise and resources that most emergency departments lack. For example, EDs are not designed for extended patient stays, as they lack a safe and therapeutic environment to optimally care for behavioral health patients.

Unfortunately, lack of psychiatric beds and professionals—especially in rural areas—means it can take hours or days to place a patient in the appropriate facility.

Boarding in the emergency department not only impacts ED throughput and safety, but is also resource intensive, often requiring a constant observer. Consequently, these situations contribute to ED staff frustration, emotional turmoil and burnout.

Ideally, hospitals and health systems would respond to current trends by prioritizing strategies that improve patient transfer, but most simply lack the in-house resources, operational capacity or expertise. For this reason, the business case for outsourcing centralized transfer operations is an easy one to make.

A better approach to behavioral health transfer

To get out in front of bottlenecks experienced in trying to place behavioral health patients, Mercy Health — Springfield Regional Medical Center worked with its partner to implement centralized patient transfer from the ED. The overarching strategy included:

Standardized processes across physicians, clinicians, administrative staff and other clinical staff;

Ongoing governance and oversight along with evaluation and reporting;

Dedicated nurse resources to facilitate transfer processes, including identifying optimal in-network options, making calls and coordinating transportation and care needs.

The new transfer center model addressed existing stressors by providing a 24/7 operation that allowed the ED to have a single point of communication rather than allocate needed resources to make calls and coordinate placement. This freed up staff to focus on priority activity: serving patients.

The centralized transfer center model now works within a set of network parameters to identify an appropriate bed based on provider preference and patient need. Once a behavioral health placement is identified, the transfer center addresses inbound and outbound transfers, direct admissions, physician-to-physician consultations, EMS coordination and smooth handoff—ultimately removing the burden from ED staff.

Important to Mercy Health — Springfield Regional Medical Center leadership was a nurse-first approach that ensured all calls were guided by a qualified clinician to ensure patients receive the most appropriate care at the right time.

In addition to setting up a centralized transfer center, Mercy Health — Springfield Regional Medical Center also set up specific protocols related to behavioral health patients. First, a transfer checklist was developed to help move patients to their behavioral health destination in a timely manner. Clinicians gained the ability to efficiently complete the checklist at the bedside and generate an electronic bed request in the EHR, initiating transfer center involvement.

The aim of the first contact was to convey transfer details, leveraging the upfront information to streamline processes and alleviate time and frustrations for ED staff. This approach not only fostered consistency, but also established a single source of communication and truth to promote patient safety.

The new centralized transfer center and behavioral health protocol has proven its worth in terms of operational efficiencies and improvements to the quality care delivery. Bon Secours Mercy Health plans to expand on this initial effort and roll the innovative workflow to other sister hospitals. It is the organization’s hope that the behavioral health model could be replicated in other health systems grappling with similar challenges.

Dominique Wells, MSN, RN is chief operating officer at Conduit Health Partners. Susan Hawk is behavioral health system director at Bon Secours Mercy Health.