Tony Macasaet, MD, was sitting in his emergency department office at Vernon Memorial Hospital in Viroqua, a town of just 4300 people in southwest Wisconsin. He could hear a nurse trying to find beds for two seriously ill patients who needed the advanced care his 25-bed hospital could not provide.
“First, we called our first-tier hospitals, and they all said no; they are so overcapacity,” he said. “It’s not just COVID. They don’t have the staff to care for the patients. Nurses have died, become sick, burned out, and left the field for other jobs. They cannot even take life-threatening trauma. You can almost hear that fear in the voice of transfer nurse.
“You wonder, who else is calling them only to hear a no?” he said. “At one point, I timed a nurse who was calling every hospital we could find on Google Maps. It took three hours. The crazy thing is when you Google, you cannot really get a sense of whether you are getting everyone,” Dr. Macasaet said. “We developed a list on a spreadsheet, but we realized it was incomplete. Even if you find a bed, then you must have emergency medical services transport, which is often unavailable.”
That is when he and his colleagues applied a 21st century solution to the overworked system: They built an app.
If You Build It…
It began with a spreadsheet built by Craig Pierce, PA-C, who works in the Vernon Memorial ED. That spreadsheet contained information such as size and distance from Vernon Memorial for all the closest hospitals. Elizabeth Gjefle, RN, helped collect EMS data, and Maria Riley, RN, aided in establishing a vision for the app called the National Transfer Registry, or the NTR, for short, which is available from the Apple App Store and Google Play. (https://apple.co/3hFH5st; https://bit.ly/3sFMoyq.)
“This is a critical access hospital,” said William Kumprey, MD, another emergency physician at Vernon Memorial who contributed to the app. “Prior to the pandemic, it was not hard to get patients into a bigger center. Sometimes, we had trouble finding ambulances, but now we cannot find beds or ambulances. How do we not have a national system for transfers? The app was developed out of a need for something we should have developed years ago.”
Dr. Kumprey said he thinks the app will grow as hospitals realize its value, but how to get the app in the right hands has been a challenge. Ryan Holzhauer, MD, another emergency physician contributor, said the past two months have been unprecedented in finding beds and transportation for patients. “The idea for the app was to make available information that didn’t exist anywhere else,” he said.
The NTR team contracted with a developer in Pakistan to design the application, figuring they had little to lose. If they built it and people used it, the transfer issue would be more easily solved. The app could take the place of hours on the phone, time that could be better used caring for patients.
Dr. Holzhauer said he measured how long he spent asking hospitals if they had a bed. He would be referred to the transfer nurse, who asked for the same information that was requested at the beginning of the phone call. “I might do this 15 times for a bed for one patient,” he said. “How many hours a day do physicians spend doing this? How many shifts per nurse? It doesn’t make sense. With the app, you could save time on every end of the system.”
Eventually, he said, he would like to get the hospitals to start putting their bed status into the app. That way they could color-code hospital listings to determine if they can take patients.
The number of calls with which transfer nurses must deal must be overwhelming, Dr. Macaset said. “The calls might quiet down a little if we can persuade the nurses to swipe right to indicate their ICU bed status.”
Currently, the app can tell a nurse or doctor where they are in relation to the sending hospital, how many acute care beds they have, and a telephone number. That can save time and trouble for the 4600 acute care hospitals in the United States.
Dr. Macaset said they will soon be adding emergency medical service information to the app. “Interesting thing—there is no list of interfacility transfer services,” he said. Each state lists them in a different way, but the NTR team plans to assemble a list in the next few months.
They also want to include the country’s 14,600 nursing homes, he said. “We will have patients in the emergency department who we cannot send to a hospital bed because three patients are waiting for a nursing home to open up,” Dr. Macaset said. “In one situation, we called 100 nursing homes looking for a patient bed.” They also plan to include behavioral health institutions to meet other patient needs.
Improved communication will help patients, Dr. Holzhauer said. A sick person in the ED is not getting the level of care he needs and can be stuck there for hours or days. “This would incentivize hospitals to make a bed available,” he said.
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Ms. SoRellehas been a medical and science writer for more than 40 years, previously at the University of Texas MD Anderson Cancer Center, The Houston Chronicle, and Baylor College of Medicine. She has received more than 60 awards, including the Texas Human Rights Foundation Award. She has been a contributor to EMN for more than 20 years.