One call starts it all

Date: 12/18/2019

A red light flashes on phoneline one as Megan O'Roak, BSN, RN, finishes charting the vitals of the previous patient being treated 75 miles north of her Bangor office. She picks up the line and it’s an emergency department physician from a critical access hospital in Downeast Maine. His patient suffered a heart attack and needs to be transferred immediately for an emergency catheterization to open the patient’s artery.

Without skipping a beat, Megan arranges for LifeFlight of Maine to bring the patient to Northern Light Eastern Maine Medical Center, finds an available inpatient bed, and relays the patient’s condition and medical information to the clinical team. As the supervisor of the medical center’s Transfer Center and Bed Management, Megan and a team of ten registered nurses and five operations specialists respond to nearly 500 phone calls like this per day.

This is business as usual for the Transfer Center team which has grown and orchestrated time-critical transfers of approximately 56,000 patients to the medical center since its opening in 2009—all from a modest office on the medical center’s State Street campus. Most people don’t know about this team or the vital role it plays in the care of patients from all corners of the state, especially rural Maine where providers face real challenges in care delivery. The goal of the Transfer Center work is simple: Get the right patient to the right level of care for the right services.

The demand for healthcare services is higher than ever as hospitals and healthcare providers in rural Maine continue to trim services and deliver care to an aging population with fewer providers and resources. Increasingly, they turn to the state’s largest hospitals to fill in the gaps. The medical center feels that pressure in many ways, especially in the high demand for its inpatient beds. As a Level II trauma center, Northern Light Eastern Maine Medical Center is the region’s only provider of highly specialized tertiary services, including neonatal intensive care, cardiovascular surgery, robotic and advanced cancer care. The hospital often operates at or near capacity, meaning that one of its 411 beds can be hard to come by when its needed most.

That is why the Transfer Center was built ten years ago, to help manage the movement of patients transferred to and from the medical center. “Prior to the existence of the Transfer Center, patient transfers into the medical center were a bit haphazard,” remembers Norman Dinerman, MD, medical director of the Transfer Center. Upwards of 6,000 calls would come into Northern Light Eastern Maine medical center each year from hospitals around the state. “Calls would be made to the physician on duty in the Emergency Department or they would be made to individual physicians on the medical staff. The placement of the patient still had to be arranged for, but it was not in a systematic fashion nor were there metrics around the process.”

Today, the Transfer Center facilitates urgent patient evaluation, admission, or transfer to and from the medical center 24 hours a day, seven days a week with hospitals throughout Maine. As the medical director of Transfer Center and LifeFlight of Maine, Dr. Dinerman worked with medical center staff and specialty areas to create physician-driven protocols which triage and provide evidence-based care in a systematic approach for many diagnoses.  

Over the last ten years, we’ve seen our call volume triple,” says Dr. Dinerman. “We’re receiving about 15,000 transfers or patient management calls per year from all over the state of Maine. Our team is extraordinary at what they do.”

Joseph Babbitt, MD, who is both the ED physician and hospitalist at Northern Light CA Dean Hospital says that before the Transfer Center, it could take him six phone calls to coordinate transferring a patient. “Now, I make one call to the Transfer Center and say, ‘I have an unstable patient who needs to be there by helicopter ten minutes ago.’ And the answer is, ‘Yes, we'll get things rolling.’ That's the way it should work—it’s fantastic,” he says.

The Transfer Center also facilitates thousands of critical clinical discussions about patient care between rural providers and medical center specialists. “It’s very difficult to recruit physicians—we’re constantly struggling with that,” explains Daniel Herbert, MD, hospitalist at Millinocket Regional Hospital. The hospital, like many in Maine has seen its service model erode because they can’t find the personnel to fill clinical programs. “I use the Transfer Center for practice questions, for that kind of clinical discussion with the medical center’s specialists. It’s a really great service.”  

As the Transfer Center celebrates its ten-year anniversary this year, the team looks forward to their ability to expand their reach for the benefit of all patients in Maine, further advancing our concept of operating as one Northern Light Health system. “What makes the Transfer Center unique is that we’re focused on the patient first and have a vision for the future,” explains Dr. Dinerman. “I see a day when transfer centers throughout the state join and leverage their combined talent and resources to more effectively meet the demand for unscheduled care.” Dr. Dinerman adds, “We’re thinking about how to deliberately connect our statewide resources, which includes hospitals working with emergency transport, and care management under a single focus to make healthcare work better patients.”