Challenge
Martha’s Vineyard Hospital — a 25-bed, Critical Access Hospital (CAH) an affiliate of Massachusetts General Hospital and a member of Mass General Brigham, is located on an island approximately six miles off the shores of Cape Cod — partnered with Stroudwater to analyze transfer trends and define an inpatient clinical care spectrum.
Martha’s Vineyard Hospital (MVH) faces unique challenges as an island-based CAH with a population that fluctuates seasonally. Transfers must be timed carefully, as a patient is typically moved in an ambulance to a ferry for a 45-minute journey to the mainland. Ferries are weather-dependent and only run during the day, so some transfers are done via helicopter, fixed-wing aircraft, or Coast Guard cutter.
As the only hospital on the island, MVH serves the year-round population of around 20,000 and the summer population that grows to over 100,000. Hospital leaders wanted to better understand which patients they have the resources and capabilities to treat, and which patients should be transferred out to receive specialized care.
Process
MVH engaged Stroudwater to work with their team and define a clear clinical care spectrum. MVH’s project members were leaders from multiple domains, including nursing, case management, pharmacy, executives, and emergency department and hospitalist providers.
Stroudwater helped the MVH team align the project with a system-wide effort to deliver the right care at the right place: patients with complicated medical issues or trauma should be transferred to receive care in an academic medical setting, while patients with lower acuity should be treated locally.
MVH began tracking 46 items supporting clinical service line initiatives, including in primary care, medical specialties, women’s health, new services, and expanded services. The hospital used Stroudwater’s transfer audit tool to track transfer trends and follow the path of each transferred patient. By reviewing the services patients received and their discharge disposition, MVH was able to analyze cases to find potentially avoidable transfers.
Results
Stroudwater helped MVH determine key baseline data, including that their overall transfer rate from the emergency department and acute care unit was 3% to 4% — which is within the recommended range. The hospital still wanted to do a deeper analysis of transfer trends and identify opportunities for improvement.
Stroudwater and MVH found that the most frequent reasons for transfer were resource needs in interventional cardiology, orthopedic surgery, neurology, neurosurgery, and urology. The hospital doesn’t have a cath lab, so interventional cardiology patients will continue to be transferred to other facilities. MVH has recently hired another orthopedic surgeon, and they are also working on initiatives to improve transfer trends in neurology, neurosurgery and urology by offering additional services and training. The hospital also developed a detailed clinical care spectrum for pediatric patients.