Patient Transfer Services APPENDIX A Patient Transfer Services (Patient Transfer Network & Patient Transport Care Coordination) What is Patient Transfer Services? Simply put Patient Transfer Services is the overarching umbrella for 2 of our communication centers- PTN and PTCC both belonging to BCEHS Presented by Don Elzinga, Program Manager Patient Transfer Services, BC Emergency Health Services February 14, 2019

What is one of the largest and busiest emergency departments we have in the Province of British Columbia?

BC Emergency Health Services (BCEHS) !!

With over 500 medical beds,

Ten flying trauma bays and…

a waiting room of almost a 1,000,000 square kilometers!

How is it possible to run a emergency department with so many people waiting for beds? And what does every emergency department have?

A triage desk and team Do people wonder why does the emergency department asks so many questions at the triage desk? or why it takes so long to see a doctor? Because facilities across the province want to know why PTN ask so many questions, and why it take so long for an ambulance.

911 Emergency Dispatch and Patient Transfer Network (PTN) our 911 centres Triages calls around the province and uses a world renown system call MPDS- medical priority dispatch system PTN is our other triage desk, a lot of people did not know that one of PTNs major roles is to triage inter facility transfers. Most people believe PTN is just a service that connects physicians together.. We will look at that in a moment , but one of the important roles for PTN is triaging all higher level inter facility transfers. It is so important that we are involved in the conversations to understand the needs of the patients not only to triage against competing priorities within your facility and those in the province, but to also give our clinical experts the best picture they can have as they may have to determine who gets the ambulance or aircraft… the car accident? the fall off the playground? The LLTO in one hospital or the Higher level of care call in another? We often even have competing priorities in the same hospital yet different wards. These decisions may have to be made very quickly with helicopters in the air or ambulances on the way to calls, so the more information we can give our clinical experts upfront the better the overall outcome Lets look a patients journey from a 911 call to arriving at a facility and then needing higher specialized care, what you may not be aware of what is happening in the background as we at BCEHS work through this process. Video is patient journey

Sending Facility calls PTN Step #1: Sending Facility calls PTN We will go over the PTN steps required to complete an inter facility transfer

Step #2: PTN may bring a second BCEHS representative to the line, either a Nurse, Emergency Transport Physician, or Critical Care Paramedic

Step #3: PTN contacts the receiving physician/specialist and facilitates a conference with the sending site, receiving specialist and BCEHS

Health Authority Referral Pattern When a physician calls for help, PTN follows the referral pattern again given to them by the health authorities, similar to one here

Health Authority Services After the referral patterns comes services, once the sending facility has been identified, PTN will find the receiving facility based on the referral pattern and then finding the closest facility that has the services required.

In this example Hospital JKL has a patient with Burns and calls PTN, PTN is aware that PQR and STU does not have Burns as a service. so PTN connects JKL directly with XYZ again based on the fact that XYZ is in the referral pattern that was established within that health authority. There is a lot of frustration across the province when the physician or facility representative goes outside the designated referral pattern and wants their patients moved to a different facility. This is a very large concern near the Alberta border, many of the physicians are wanting their patients especially Alberta residents to go to an Alberta facility. In fact in the case of the Alberta border, we do not have a referral pattern from the health authorities that are specific to Alberta residents, and as well Alberta itself is not accepting stable patients from BC regardless of residential status, PTN is not the reason patients are not going to facilities that physicians are asking them to go to

Step #4: PTN contacts the receiving hospital and requests acceptance of the patient to a bed

Step #5: Wait for a bed…. On a random day in September we had 92 patients in the Province waiting for a bed This is where there is a huge disconnect across the province, even though the physician has accepted the patient, the hospital may not have, and in the case of higher level of care – yellow transfers they may tell PTN I’ll call you back when I have a bed but don’t bring them now. This effects everything from clinics closing to ferry transfers and many of you tell the crews when they arrive “what took you so long we booked this 6 hours ago”

Step #6: Once a bed is offered the transfer is moved to the ambulance side of the house (air or ground) and resources sent based on acuity and availability

Challenges PTN Faces 1) Conferences outside of PTN 2) Physicians wanting to go to facilities not in referral patterns 3) Waiting for beds 4) Over capacity and non-refusals 1)This creates more time spent on the phone repeating the story as you will have to repeat the story to BCEHS anyway 2)Calling the wrong location from the health authority referral pattern. Having to possibly start again and then more time spent on the phone 3)BCEHS is not able to triage the transfer appropriately. Or get the full picture 4)PTN also has to follow up with the receiving facility to confirm timelines and speak to the specialists again after they had already spoken to the sending

Helicopter (Rotary) Jet (Fixed Wing) Turbo Prop

More Aircraft?

Or More Efficiency? a random day in September PTN BC Ambulance a random day in September 92 patients waiting for beds across the Province 27 patients ready or being transferred

Medical Escorts

Non Medical Transfers

Going Forward BCEHS Provide further education to Primary Care Paramedic staff Looking at deployment models for both air and ground Clinical Response Model Community paramedics Creating an online dashboard to see patient movement in real time Provincial Patient Transfer Services Advisory Committee Referral patterns Roles and responsibilities Education back to “all” front-line staff Standardizing processes Creating new processes where they don’t exist Joint procedures and Standard Operating Guidelines