One-hundred ninety-eight minutes. That’s, on average, how long it took Banner Health to accept patient transfers from outside facilities in 2018: more than three hours.
A patient’s condition could change drastically during that time, said Charley Larsen, senior director of Banner’s transfer services. His team manages coordinating patient transfers from outside facilities into care sites across Banner’s Arizona region, many of whom come from the emergency departments of nearby competing hospitals.
“By the time we were able to work the process and get (a patient) to the next facility, sometimes it was a vastly different patient,” Larsen said.
That’s if the patient even arrived at a Banner facility. Outside hospitals want to transfer a patient quickly—and if it takes too long for Banner’s access center to find a bed, they might direct the patient elsewhere. Those facilities “send us a referral, but they send that same referral to everybody else,” Larsen said. “From a business perspective, it’s first come, first served.”
That was hitting Banner’s bottom line.
Manual processes, like phone calls, took up most of the three-hour time frame. That’s because it’s not just transferring patients to the closest emergency department, Larsen stressed. After determining which service line a patient should be directed to, staff would call the unit they thought was the best fit based on the patient’s clinical condition and proximity to determine whether there was space to admit them.
It sounds simple enough. But it was often challenging to find the most up-to-date information for individual units across the entire Arizona region, as on-call status reports were held on static documents that weren’t updated frequently. If the unit in question didn’t have room for another patient, the access center would have to start the process all over again.
Banner estimated that its slow transfer process contributed to around 600 lost patient referrals each month. That could add up to an estimated $40 million in annual revenue.
So in January of last year, Larsen’s team implemented a new software system designed for access centers. The goal was to automate the manual processes—centralizing charting into one system, keeping a regularly updated log of physicians on call in different units and tracking capacity at units across the region.
Banner is part of a growing segment of health systems with access centers that centralize patient intake services across their sites, said Pam Arlotto, CEO of healthcare consultancy Maestro Strategies. She said she’s seen interest in these types of centers rise over the past five or so years.
But since access centers are an emerging part of the healthcare industry, health systems are still figuring out best workflows—including implementing new processes to streamline clinical intake, scheduling and patient throughput when managing referrals. Arlotto cautioned that it’s not as simple as deploying technology tools for these purposes.
Instead, health systems often have to design new systems that are interoperable with the organization’s other IT systems and customized to various providers’ preferences and capacities.
“You have to design it for your environment, for your patient population, for your caregivers,” Arlotto said. It takes experimentation to figure out what processes work best; trying out different projects, and then scaling the ones that work. “It’s more iterative and incremental innovation,” she said.
One portion of the new system that’s proved particularly helpful for Banner involved the health system working together with the software developer, Central Logic, to build an interface with Banner’s separate registration system. That interface provides the access center with a view of available beds in individual units throughout the system, updated every 60 seconds.
That replaced a spreadsheet the access center kept, where nurses would manually label whether each facility had the capacity for additional patients. While the spreadsheet had worked for coordinating capacity at individual units and facilities, the access center “outgrew” it as it took on managing transfers for Banner’s larger Arizona region, Larsen said.
Larsen is working to phase out that spreadsheet for facilities across Banner’s Arizona region.
Since 2018, Banner has seen a 7% increase in referral volume. Larsen largely attributes that to efficiencies that helped cut the system’s transfer time, although the system has also kicked off initiatives to grow referral volume through other efforts, like building closer relationships with rural facilities in the area. Banner’s time to accept patient transfers has dropped 22% from its initial 198 minutes.
“It all boils down to how long it takes to transfer,” Larsen said. “If you want more volume, then be quicker.”
