BEYOND CAPACITY: Navigating the Challenges of Transfers

Much has changed in medicine post-pandemic.  Arguably the most significant change has been the loss of much of the medical workforce, and no one in medicine has been immune from the effects of that loss.

One particular effect that Docs Who Care has seen across all of our states is that many of our typical referral centers have been at or beyond capacity regularly, not because there aren’t more physical beds available, but because there aren’t enough nurses to staff those beds.  Thus, normal transfer protocols have been upended across many of our partner facilities.  And most projections indicate this will be the new normal for years to come.

Unfortunately, our fractured health system is not equipped to solve this problem globally, and most of our partner hospitals have been left to fend for themselves, figuring out how to deal with large numbers of patients they could easily transfer and accommodate four short years ago.

Many of you have likely faced this challenge.  Do you admit patients whose needs potentially exceed the comfort level or skills of the local staff?  Do you transfer patients six hours away, where family and loved ones can’t readily travel and where eventual follow-up becomes quite challenging?  Do you board sick patients in your local ED, possibly for days at a time, awaiting an available bed at your typical referral center, thereby taking up precious local ED resources and already limited space?

There are no easy answers to these questions, and the answers are often different depending on where you are.  Our approach with Docs Who Care has always been to partner with our hospitals on a local level to find solutions to whatever challenges our communities face.  It is no different here.

And as with so many of those challenges, the solution often comes down to clear communication.  Our physicians and APPs work not as individuals, but as part of a team in whatever setting we find ourselves.  So, we must bridge the gaps that we find by communicating effectively with our ED and hospital staff, our hospital administrators, and Docs Who Care.

Sometimes the challenge of getting everyone on the same page about the best course of action can be more difficult than managing a complex medical patient.  But it’s no less essential to caring for those patients.

As you navigate those challenges, remember that you’re not alone.  It is essential that you communicate with your local resources to try to achieve an outcome that is most agreeable to everyone.  If you feel you are unable to navigate those communications effectively, please reach out to your Docs Who Care site medical director or team leader if there is one.  If there isn’t, your state medical director would be happy to help, as will our Docs Who Care administrative team.

As the saying goes, teamwork makes the dream work, and that’s a mantra we always hope will be part of whatever new normal we find ourselves in.

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Dr. Andy Bukaty is beginning his 19^th year working with Docs Who Care. He currently serves as ED Medical Director at Clarke County Hospital in Osceola, IA, and in 2022 became the Chief Medical Director for Docs Who Care. Andy is married to his wife Joan, and they have one daughter and one son at home who rule their world.   In his spare time, Dr. Bukaty serves on the Board of Directors of KyMel – a nonprofit organization creating connecting experiences for families with children on the cancer journey.