Optimizing Patient Triage, Transfer Workflows to Meet Surges in Health Care Demand

Cheryl Dalton-Norman, MBA, BSN, RN, president and cofounder, Conduit Health Partners, comments on how the combination of RSV, COVID-19, and flu impacted health systems, as well as how organizations can optimize their workflows to meet surges in demand.

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I am Cheryl Dalton-Norman, president of Conduit Health Partners. I've been a nurse for 40 years and cofounded Conduit Health Partners about 6 years ago. We were looking to solve for problems within 1 health system but found that our solutions and what we do was able to help many health systems across the country. Excited to be here today.

How do surges in health care demand typically affect the quality of patient care?

Many of you have probably heard about situations where, during the height of COVID-19, patients were arriving in emergency departments and 1) were not able to access care within the emergency department, or 2) if they accessed that care and needed a higher level of service than the location where they were, they couldn't get the transfer. There are stories about patients dying in one hospital, because they couldn't get transferred to a different hospital that offered the service that they needed. 

When there are really big surges in patients needing health care, solutions like triage and transfer centers can lift that burden from the bedside caregivers and help get people to the right level of care.

If folks were balanced and able to get where they needed to be, rather than all going to the same place—whether that be the emergency department, urgent care, or their physician practice—if they have a professional that can help them think about where the best level of care is, that helps to lift the burden from the bedside and makes sure people get what they need quickly.

How has the recent COVID-19, RSV, and influenza “tripledemic” impacted workflows related to patient triage and transfer?

I'll start first with the transfer center. What we have seen during the tripledemic is that it takes many more calls to different facilities to find locations that have available beds, staff, and service. For organizations that don't have a very well defined transfer center process or a partner that can do that for them, they're pulling nurses and providers from the bedside and spending hours just trying to get a patient moved to a location where they can receive definitive treatment. 

When you have a transfer center partner or a really great process internally that doesn't draw from bedside caregivers, then you can be much more successful in taking great care of patients, which is what everyone wants to do. When you think about nurse triage, the volume of calls that often come into physician practices; that go to insurance company triage lines; that go to a lot of different places, can be overwhelming.

It's really hard for a physician practice, emergency department, or health system to navigate managing all those inbound calls, because people are just scared. Sometimes people don't necessarily need treatment. They need reassurance that what they're experiencing is normal, and by doing certain things at home, they can safely remain at home and not overcrowd an emergency department or sit in a practice for hours, waiting for the doctor to see them. 

One of the consequences that we see is provider burnout. Provider burnout is a really big deal right now. Nursing recruitment is a challenge across the country; having physicians rested and available to take care of patients is a challenge across the country. There was a recent survey done where health care executives were asked, "What's your number one concern?" Workforce is the number one concern. Having partners that can lift that transfer and triage burden and attend to patient needs is a huge help in workforce satisfaction, reducing provider burnout, and just ensuring that patients get great care.

What advice would you offer organizations seeking to respond to spikes in demand more efficiently?

I think the first thing providers need to do is understand what's actually going on in their emergency departments, physician practices, out on the floors, and in their units. 

As health care executives—and having been one for a really long time, I can relate to this—people tell us often what we want to hear or what they think we want to hear. And it's important to understand, what is the lived experience of a nurse, tech, or physician in the middle of the night on Saturday? What challenges are they really facing? 

After understanding those challenges and how they’re impacting great care for patients, it's important to say, "What are the things that I don't need a live person at the bedside to do?”

Let's let nurses nurse and doctors doctor. But what doesn't need to happen right there at the bedside? What are things that, if somebody remotely or virtually were helping us with this, would make the lives of our caregivers better? That would be my recommendation for health care executives, as they're navigating volume and tripledemic challenges. 

When you think about lifting the burden from the bedside, I do think it's important to think about the folks that are doing that. One of the things we believe in at Conduit is to have nurses be that first line of contact with patients. A lot of times, you might have a person who is not a health care professional answering that call first, and we believe that is leading to a delay in care. When I'm calling you because I have a health care concern, I want to talk to someone who can help me on the first call, and not have to call me back an hour or two later.

Within Conduit, we believe it's important to have that nursing-led model, where the first point of contact in triage when a patient calls is a registered nurse. In the transfer center, when a physician is calling, wanting to get a patient moved, having a registered nurse who can understand the clinical needs of the patient is important. They can make sure we're seeking out the right point of care for that patient and are able to convey the gravity of the patient’s situation to receiving organizations. So we believe a nursing-led model is important for the welfare of patients and to really deliver a top-tier experience for clients.

Is there anything else you would like to add?

Beyond the tripledemic, health care organizations experience a continuous challenge. Here in South Carolina, where I am, I read a news article the other day where a community member went to social media to describe the delay in care her father received. He lay in a hall bed for 12 hours. I felt sympathy and empathy for both the health care system that was involved, and especially for this daughter and her father experiencing this. 

The challenge that we're trying to solve for is removing the unnecessary work that sits on nurses and physicians in our health care systems, so that we can expedite the care of patients. Whether it's a tripledemic or not, I've got resources that are helping me address patient needs and concerns in the face of really challenging staffing times. I don't see those getting better anytime soon. So having a partner that can do things virtually can really help expedite the care of patients, whether you're in a tripledemic or an ongoing state.