Providing prompt access to critical information during inter-hospital transfers
6 September 2022
Comprising of eight hospitals and four community health facilities, Mackay Hospital and Health Service (HHS) is located 1,000km north of Brisbane and provides extensive health services in a range of regional, community and rural settings, to a population of approximately 180,000 people.
The inter-hospital transfer of critical patients from rural and remote facilities to the Mackay Base Hospital emergency department is a crucial transition point in patient care, and in many cases this process can prove to be complex and inconsistent. This can result in miscommunication, unnecessary duplication of tests, patient deterioration and a loss of clinical treatment time. Using the documentation capabilities of the integrated electronic medical record (ieMR), the team at Mackay HHS have streamlined inter-hospital transfer communication, resulting in improved handover workflows and enhanced patient safety.
With numerous patients to care for, paper inter-hospital transfer forms and the requirement for swift clinical handovers to Retrieval Services Queensland (RSQ), clinicians at Collinsville Hospital (a small rural facility 280 kms north-west of Mackay) were finding it challenging to complete consistent and detailed documentation for patients being transferred by air or road to the Mackay Emergency Department. “With shift work, and planes and helicopters not always being available – or higher acuities being diverted – it just makes communication difficult,” said Dr Sebastian Stephens from Collinsville Hospital.
Enhanced decision support through timely documentation
With a recognition that this process was not working efficiently, a specific location was created for a pre-arrival encounter to be used by Collinsville. This enabled Dr Stephens to document his clinical handover and notes for transfer patients directly into the ieMR, meaning all treating clinicians across the state – and with sufficient access permissions – could view the information.
With this specified workflow, Dr Stephens could provide detailed notes to be viewed by the treating clinicians at Mackay Emergency Department ahead of a patient’s arrival via helicopter or ambulance. This process has also been used to transfer patients to Cairns and Hinterland HHS.
The enhanced process proved immediately useful in the case of a dehydrated paediatric patient who required a swift air transfer to Mackay. At the time of transfer, the patient’s diagnosis was unclear. However, the ability to update the patient’s record in real-time meant that the clinical team in Mackay were able to access updates ahead of the patient’s arrival. “The beauty of having created the encounter was that in the morning, when we got a test result back that changed everything, I was able to write the update in red in ieMR whilst the patient was in the air,” said Dr Stephens. The registrar in Mackay opened ieMR and – having seen the note that was updated at 8:30am in the morning – was able to treat the patient for a lingering infection upon arrival in Mackay. “Creating this location and note allows you to make crucial real-time updates and provide prompt access to critical information,” said Dr Stephens.
Streamlining inter-hospital transfer communications
Dr Pieter Nel, chief digital director of Medical Services at Mackay HHS said that he believes that this functionality improves patient care and patient flow. “You can plan for the patient’s arrival, you know what has been done already, you don’t have to repeat everything, and you know exactly what needs to be done in ED and who needs to be involved. It’s absolutely a life changer for us here in the emergency department,” said Dr Nel.
Mackay HHS plan to roll this process improvement out to Bowen, Proserpine and Sarina hospitals once some final workflow checks have been completed.