Health systems nationwide have faced growing capacity challenges. So when Mass General Brigham launched its Patient Transfer and Access Center in October, the goal was to increase access and capacity for patients, particularly the sickest, across its academic medical centers and specialty and community hospitals. Nearly one year later, the health system is seeing progress toward this objective, its senior medical director of clinical integration told Becker's.
Kyan Safavi, MD, noted a particular six-month milestone: a 10% increase in transfer completion rate to academic medical centers (7,622 transfers) from October to March at the Somerville, Mass.-based health system. The increase resulted from fewer duplicate requests and more successful transfers.
While this milestone is significant, much work lies beneath the number, as do many mechanisms, Dr. Safavi said.
Mass General Brigham operates five academic medical centers, notably Massachusetts General Hospital and Brigham and Women's Hospital, both in Boston. The system also includes 13 community hospitals.
Dr. Safavi said with this size in mind, the organization needed a system to understand all these assets, understand the real-time capacity situation and status of those assets, and then be able to leverage them seamlessly.
"For us that's really about matching patient needs with appropriate sites of care or capability within our system," he said. "Historically, every hospital functioned separately and took transfer requests and managed access individually.
"We were not aware of, for example, when, for a single patient, a hospital may call multiple hospitals simultaneously. We were doing redundant work. We weren't able to leverage each other easily. If one hospital was out of capacity or extremely overloaded and another had capacity, there was no system in which to ensure that what we're leveraging the place that does have the capability and capacity."
This provided motivation to establish such a system, which ultimately resulted in the transfer and access center. The transfer and access center serves as a single access line, a single triage process, a single team working through patient transfer requests into the system, Dr. Safavi said.
"And our bed managers are colocated with us," he said. "We're plugged in very closely to the on-site roles that also are bringing important perspectives and help get the patients in."
In the end, the center works to match patient needs with sites of care. One example cited by Dr. Safavi involves patients coming out of Martha's Vineyard or Nantucket. Those patients historically would most often go to Mass General Hospital and sometimes to Brigham.
"But we realized many of those patients could be well served in our highly capable community hospitals," he said. "This is an example of how we're leveraging the whole system to increase the opportunities to get the patient the care they need."
Underneath the 10% increase in transfer completion rate to academic medical centers, Mass General Brigham has achieved other successes. From October to March, there was a 56% growth in repatriation — the returning of patients who were transferred into academic medical centers back to their original hospital, when medically appropriate, to recover. And it has pivoted nearly 400 patients across academic medical centers through July.
"That's where we try to get to Mass General Hospital, let's say, but there's no capacity so we direct to Brigham, and Brigham is able to take them and vice versa," Dr. Safavi said. "That helps the patient get in faster. These are usually sickest patients, and this helps prevent leakage out of our system."
Even with the successes, he acknowledged the challenges involved in establishing a single integrated access line and triage process across a system such as Mass General Brigham.
There are "many processes to get a patient physically into the hospital or even to get a physician on the line to hear a case," Dr. Safavi said. "Those can differ across the hospitals, so it can be challenging when the team needs to manage and keep in their heads policies and multiple ways of doing something across so many hospitals. The learning curve is significant.
"Over time, what we're learning is we can bring together departments from across hospitals, learn the best practices, and develop a single approach that's easier to follow for the transfer center staff, but also beneficial for the staff getting on the phone, and ultimately the patients. So the access center has been a tip of the spear of what it means to integrate clinically and operationally across the system. It's been a nice evolution in working with departments."
He credited the chairs and the clinical leadership throughout the system with helping the process go smoothly and navigating the complexity involved. Dr. Safavi said they all bought in fully to take a patient-centered approach.
"Then it was straightforward to talk about how we can use this common triage and access process to get patients the best care the fastest. That was critical, and it's a fair and equitable system, and it's a patient-centered system," he said.
"A huge credit goes to them. They moved forward with us, partly because they saw those components, and we followed along together closely with the data."
Additionally, Dr. Safavi credited those coordinating the transfers, such as transfer center nurses, the case managers in the transfer center, the bed managers with whom they work to get patients a bed, the nursing supervisor and float nurses on the ground at the hospitals.
"All of those individuals were willing to drink from the fire hose and learn a totally new system and way of doing things," he said. "They bought in because they saw the alternate vision and that we're in it for the patients."
He noted that the community hospitals were also willing to change how they do things and take on sicker patients to unlock capacity at the academic medical centers.
"Change at that scale and level is massive for individuals and needs to be respected with how hard that is for people," Dr. Safavi said. "We've gone through that experience. We've learned from our staff. We've learned how to support them better, and that will be a never-ending thing for us. We're excited because we're building the foundation of a culture that is really supportive of our teams and focused on the incredibly important lifesaving work they do."
For other systems considering similar approaches, he advised listening to feedback constantly, in a non-defensive way, while "understanding you're not going to get everything right."