How Carilion Clinic improved transfers and expanded capacity

Years ago, the Carilion Clinic didn’t have to worry as much about capacity.

Carilion, a six-hospital system based in Roanoke, Virginia, focused on serving as many patients as possible, Dr. Paul Haskins recalls.

Haskins, senior vice president of the Carilion Transfer and Operations Center, said patient volumes began climbing. And that led to the need for a new approach.

“Over the past decade, what has happened is your patient volumes have gone up, your staffing numbers have gone down a little bit. Your space has been constricted,” he says.

Carilion established a command center to better handle volume across the system’s six hospitals and help facilitate transfers to post-acute facilities. Working with Teletracking, a firm based in Pittsburgh, the company has helped improve capacity in the system and helped move out patients who don’t need to be in the hospital any longer.

In an interview with Chief Healthcare Executive®, Haskins says that the goal is to help serve more patients.

“The most important patient is one that hasn't gotten here,” Haskins says. “So you have to try and maximize your ability to get them here by decreasing your length of stay and getting those patients that are already stabilized out of the system into their next course of care.”

Carilion began its partnership with Teletracking in 2004. With a more centralized approach, the health system managed to streamline the process of finding rehabilitation facilities or nursing homes for patients that didn’t need acute care.

Haskins says that’s been a key to helping reduce the length of stay for some patients.

“The sooner you can sort of start working on that discharge plan, the sooner you can get patients to the appropriate level of care post-discharge,” he says.

The command center approach has also enabled the system to utilize existing capacity within the system, tapping a hospital that may have more beds and easing pressure on a facility that is overflowing. This also helps maintain high quality patient care, he says.

Plus, better knowledge of capacity and available beds at post-rehab facilities can help some patients find placements near their community.

“By knowing what they have available as far as beds and what they have available as far as the ability to care for patients, you can maximize your patient stay, sometimes keeping those patients in the area that they live a little closer to family,” he says.

“Our catchment area is 250 miles by 250 miles,” Haskins says. “So if we can keep our patients close to family, overall, it's better for the system, it's better for the family, it's better for the patient.”

Roanoke is home to about 100,000 people, but the city in southwest Virginia is also surrounded by very rural areas, and Haskins notes there’s a limited number of hospitals.

That underscores the need for helping patients get transferred when they no longer need to be in the hospital, since others are waiting.

“We have to do everything in our power to make beds available for those patients,” he says.

An emergency physician, Haskins says the command center has been staffed with nurses trained in emergency medicine and critical care.

The nurses have a good amount of experience, and he says that’s invaluable in helping find good placements. And it helps save time for doctors and patients.

“The right call the first time is the important one,” he says.

Carilion serves a patient population with complex needs. With an aging population that is likely to need more healthcare services in the future, Haskins says the continued success in facilitating patient transfers becomes more important.

“You have to do your best to get those patients out of the hospital, to bring in another patient,” he says.

Since establishing the command center, Carilion Clinic has received visits from officials at other hospitals looking to get guidance in setting up similar systems in their own organizations, Haskins says.

He says the approach can be utilized in larger health systems as well as smaller organizations. But he says the command center and transfer process has to be developed carefully.

Without good planning, Haskins says it’s like putting a Lego set together but not using some of the pieces in the right way.

“You’ve got to have really good technology,” he says. “You have to have the right people, and you have to develop your processes. This isn't like you plug and play. You have to develop all those things.”