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“Nobody is happy when a patient needs to be transferred.” As the general surgery group who receives requests for transfer of patients to our tertiary care hospital, we understand and sympathize with many of the issues raised in Dr. Puls’ article (“Rural Surgery – A view from the front lines” ‘I need to transfer this patient,” ACS Surgery News, September 2018, p. 7).
There is no doubt that sometimes patients benefit from support only available at a tertiary care center. The need can be for subspeciality surgical expertise, but many times it is driven by other available hospital-level support (critical care, interventional radiology, etc.).
Transfers are time consuming for physicians on both ends – while referring physicians have the responsibility of reaching out, accepting physicians have the responsibility of timely response to a request, regardless of other demands on their time and attention. We agree wholeheartedly with Dr. Puls’s argument that the phone call process “should not be delegated to the hospitalist or anyone else.” The benefit of speaking directly to the surgeon who has personally evaluated the patient cannot be overemphasized. When referrals for surgical care are initiated by the hospitalist or emergency department physician caring for a patient, there is almost always a lack of clarity around the surgical history, reason for transfer, and ongoing needs of the patient. It is our practice to request to speak to the surgeon who has evaluated and cared for the patient so we can fully understand the clinical course. It is the rare, typically life-threatening, situation in which we transfer patients without this crucial conversation.
Another crucial conversation, one in which the receiving physicians have room for improvement, is that of closing the loop after transfer. Dr. Puls recommended that there be periodic communication between the referring physician and the accepting physician, as well as closing the loop at the time the patient is discharged. There is a lack of “best practice” and infrastructure to support this work in many institutions, including ours, in part complicated by the variable EHRs utilized by individual hospitals. We believe the burden of this communication is shared by both parties and critical to optimal patient outcomes. At our hospital, we are currently working on standardizing this process and hope it will continue to strengthen the relationships we are building with our community surgeons.
At the end of the day, referring physicians and accepting physicians should function as team members with a shared goal – to always provide excellent surgical care to patients, by optimally matching patient needs with appropriate resources. or this reason, we disagree with Dr. Puls’ statement that “accepting physicians at larger hospitals should be treated like gold.” The work of “networking” should not be placed solely on the shoulders of rural surgeons. We believe it is best practice for the tertiary care hospital team to visit their community hospitals to better understand their resources, rather than the other way around. The Atrium Health National Surgical Quality Improvement Program Collaborative has been a valuable platform for making these connections for hospitals within our system and provides infrastructure for ongoing collaboration. Surgeons at tertiary care centers should also make themselves available for phone consultation for the complicated patient for whom a surgeon may simply need a second opinion. Not all “transfer calls” result in a transfer, and if both parties agree that the patient can continue to receive the same care at the local hospital that is often in his or her best interest.
Strengthening relationships with our community surgeons will allow surgeons at tertiary care centers to partner with them to optimally match patient needs to available resources. We truly appreciate our referring surgeons and thank them for the incredible work they do in serving our communities. Without their care on the front lines, we would not be able to provide the complex care and support to patients who need it most.
I very much appreciate the comments made by Drs. Reinke, Matthews, Paton, and Schiffern of the Carolinas Medical Center, Atrium Health, regarding my commentary on a rural surgeon’s take on transferring patients. They have provided the important perspective of the surgeon at a tertiary care center accepting a transferred patient. They also point out some of the important responsibilities that accepting surgeons have regarding the patient transfer process. If all tertiary facilities had the philosophy described by Drs. Reinke, Matthews, Paton, and Schiffern regarding patient transfers, many more patients would benefit
I agree that more easily arranged phone consultations between a rural surgeon and a tertiary surgeon regarding the need for a potential patient transfer would be helpful. Sometimes the simple reassurance from a tertiary care surgeon that the rural surgeon is doing the right thing, and the comfort the patient and his/her family derives from knowing that their surgeon has spoken with a surgeon at a tertiary care center, can be enough to prevent the need for an immediate transfer.
I also agree that “closing the loop” after a transfer is an important responsibility of both the transferring surgeon and the accepting surgeon. This is difficult partly because everyone is busy, but also because of factors such as the incompatibility of EHRs. Perhaps if part of the transfer process involved the transferring surgeon and accepting surgeon exchanging cell phone numbers and email addresses, then a quick phone call, text, or email every couple of days could help to “close the loop.
I accept their mild criticism of my statement that “accepting physicians at larger hospitals should be treated like gold” since they really are saying that there is a shared responsibility between tertiary care surgeons and rural surgeons to develop relationships that allow for the optimal care of transferred patients. I couldn’t agree more with their statement that “referring physicians and accepting physicians should function as team members with a shared goal – to always provide excellent surgical care to patients.” When we do this, we are treating the patient like gold, which is our ultimate objective.
Mark Puls, MD, FACS, is a general surgeon in Alpena, Mich. He serves as vice chair of the ACS Advisory Council for Rural Surgery. octor’s Name and Bio
I very much appreciate the comments made by Drs. Reinke, Matthews, Paton, and Schiffern of the Carolinas Medical Center, Atrium Health, regarding my commentary on a rural surgeon’s take on transferring patients. They have provided the important perspective of the surgeon at a tertiary care center accepting a transferred patient. They also point out some of the important responsibilities that accepting surgeons have regarding the patient transfer process. If all tertiary facilities had the philosophy described by Drs. Reinke, Matthews, Paton, and Schiffern regarding patient transfers, many more patients would benefit
I agree that more easily arranged phone consultations between a rural surgeon and a tertiary surgeon regarding the need for a potential patient transfer would be helpful. Sometimes the simple reassurance from a tertiary care surgeon that the rural surgeon is doing the right thing, and the comfort the patient and his/her family derives from knowing that their surgeon has spoken with a surgeon at a tertiary care center, can be enough to prevent the need for an immediate transfer.
I also agree that “closing the loop” after a transfer is an important responsibility of both the transferring surgeon and the accepting surgeon. This is difficult partly because everyone is busy, but also because of factors such as the incompatibility of EHRs. Perhaps if part of the transfer process involved the transferring surgeon and accepting surgeon exchanging cell phone numbers and email addresses, then a quick phone call, text, or email every couple of days could help to “close the loop.
I accept their mild criticism of my statement that “accepting physicians at larger hospitals should be treated like gold” since they really are saying that there is a shared responsibility between tertiary care surgeons and rural surgeons to develop relationships that allow for the optimal care of transferred patients. I couldn’t agree more with their statement that “referring physicians and accepting physicians should function as team members with a shared goal – to always provide excellent surgical care to patients.” When we do this, we are treating the patient like gold, which is our ultimate objective.
Mark Puls, MD, FACS, is a general surgeon in Alpena, Mich. He serves as vice chair of the ACS Advisory Council for Rural Surgery. octor’s Name and Bio
I very much appreciate the comments made by Drs. Reinke, Matthews, Paton, and Schiffern of the Carolinas Medical Center, Atrium Health, regarding my commentary on a rural surgeon’s take on transferring patients. They have provided the important perspective of the surgeon at a tertiary care center accepting a transferred patient. They also point out some of the important responsibilities that accepting surgeons have regarding the patient transfer process. If all tertiary facilities had the philosophy described by Drs. Reinke, Matthews, Paton, and Schiffern regarding patient transfers, many more patients would benefit
I agree that more easily arranged phone consultations between a rural surgeon and a tertiary surgeon regarding the need for a potential patient transfer would be helpful. Sometimes the simple reassurance from a tertiary care surgeon that the rural surgeon is doing the right thing, and the comfort the patient and his/her family derives from knowing that their surgeon has spoken with a surgeon at a tertiary care center, can be enough to prevent the need for an immediate transfer.
I also agree that “closing the loop” after a transfer is an important responsibility of both the transferring surgeon and the accepting surgeon. This is difficult partly because everyone is busy, but also because of factors such as the incompatibility of EHRs. Perhaps if part of the transfer process involved the transferring surgeon and accepting surgeon exchanging cell phone numbers and email addresses, then a quick phone call, text, or email every couple of days could help to “close the loop.
I accept their mild criticism of my statement that “accepting physicians at larger hospitals should be treated like gold” since they really are saying that there is a shared responsibility between tertiary care surgeons and rural surgeons to develop relationships that allow for the optimal care of transferred patients. I couldn’t agree more with their statement that “referring physicians and accepting physicians should function as team members with a shared goal – to always provide excellent surgical care to patients.” When we do this, we are treating the patient like gold, which is our ultimate objective.
Mark Puls, MD, FACS, is a general surgeon in Alpena, Mich. He serves as vice chair of the ACS Advisory Council for Rural Surgery. octor’s Name and Bio
“Nobody is happy when a patient needs to be transferred.” As the general surgery group who receives requests for transfer of patients to our tertiary care hospital, we understand and sympathize with many of the issues raised in Dr. Puls’ article (“Rural Surgery – A view from the front lines” ‘I need to transfer this patient,” ACS Surgery News, September 2018, p. 7).
There is no doubt that sometimes patients benefit from support only available at a tertiary care center. The need can be for subspeciality surgical expertise, but many times it is driven by other available hospital-level support (critical care, interventional radiology, etc.).
Transfers are time consuming for physicians on both ends – while referring physicians have the responsibility of reaching out, accepting physicians have the responsibility of timely response to a request, regardless of other demands on their time and attention. We agree wholeheartedly with Dr. Puls’s argument that the phone call process “should not be delegated to the hospitalist or anyone else.” The benefit of speaking directly to the surgeon who has personally evaluated the patient cannot be overemphasized. When referrals for surgical care are initiated by the hospitalist or emergency department physician caring for a patient, there is almost always a lack of clarity around the surgical history, reason for transfer, and ongoing needs of the patient. It is our practice to request to speak to the surgeon who has evaluated and cared for the patient so we can fully understand the clinical course. It is the rare, typically life-threatening, situation in which we transfer patients without this crucial conversation.
Another crucial conversation, one in which the receiving physicians have room for improvement, is that of closing the loop after transfer. Dr. Puls recommended that there be periodic communication between the referring physician and the accepting physician, as well as closing the loop at the time the patient is discharged. There is a lack of “best practice” and infrastructure to support this work in many institutions, including ours, in part complicated by the variable EHRs utilized by individual hospitals. We believe the burden of this communication is shared by both parties and critical to optimal patient outcomes. At our hospital, we are currently working on standardizing this process and hope it will continue to strengthen the relationships we are building with our community surgeons.
At the end of the day, referring physicians and accepting physicians should function as team members with a shared goal – to always provide excellent surgical care to patients, by optimally matching patient needs with appropriate resources. or this reason, we disagree with Dr. Puls’ statement that “accepting physicians at larger hospitals should be treated like gold.” The work of “networking” should not be placed solely on the shoulders of rural surgeons. We believe it is best practice for the tertiary care hospital team to visit their community hospitals to better understand their resources, rather than the other way around. The Atrium Health National Surgical Quality Improvement Program Collaborative has been a valuable platform for making these connections for hospitals within our system and provides infrastructure for ongoing collaboration. Surgeons at tertiary care centers should also make themselves available for phone consultation for the complicated patient for whom a surgeon may simply need a second opinion. Not all “transfer calls” result in a transfer, and if both parties agree that the patient can continue to receive the same care at the local hospital that is often in his or her best interest.
Strengthening relationships with our community surgeons will allow surgeons at tertiary care centers to partner with them to optimally match patient needs to available resources. We truly appreciate our referring surgeons and thank them for the incredible work they do in serving our communities. Without their care on the front lines, we would not be able to provide the complex care and support to patients who need it most.
“Nobody is happy when a patient needs to be transferred.” As the general surgery group who receives requests for transfer of patients to our tertiary care hospital, we understand and sympathize with many of the issues raised in Dr. Puls’ article (“Rural Surgery – A view from the front lines” ‘I need to transfer this patient,” ACS Surgery News, September 2018, p. 7).
There is no doubt that sometimes patients benefit from support only available at a tertiary care center. The need can be for subspeciality surgical expertise, but many times it is driven by other available hospital-level support (critical care, interventional radiology, etc.).
Transfers are time consuming for physicians on both ends – while referring physicians have the responsibility of reaching out, accepting physicians have the responsibility of timely response to a request, regardless of other demands on their time and attention. We agree wholeheartedly with Dr. Puls’s argument that the phone call process “should not be delegated to the hospitalist or anyone else.” The benefit of speaking directly to the surgeon who has personally evaluated the patient cannot be overemphasized. When referrals for surgical care are initiated by the hospitalist or emergency department physician caring for a patient, there is almost always a lack of clarity around the surgical history, reason for transfer, and ongoing needs of the patient. It is our practice to request to speak to the surgeon who has evaluated and cared for the patient so we can fully understand the clinical course. It is the rare, typically life-threatening, situation in which we transfer patients without this crucial conversation.
Another crucial conversation, one in which the receiving physicians have room for improvement, is that of closing the loop after transfer. Dr. Puls recommended that there be periodic communication between the referring physician and the accepting physician, as well as closing the loop at the time the patient is discharged. There is a lack of “best practice” and infrastructure to support this work in many institutions, including ours, in part complicated by the variable EHRs utilized by individual hospitals. We believe the burden of this communication is shared by both parties and critical to optimal patient outcomes. At our hospital, we are currently working on standardizing this process and hope it will continue to strengthen the relationships we are building with our community surgeons.
At the end of the day, referring physicians and accepting physicians should function as team members with a shared goal – to always provide excellent surgical care to patients, by optimally matching patient needs with appropriate resources. or this reason, we disagree with Dr. Puls’ statement that “accepting physicians at larger hospitals should be treated like gold.” The work of “networking” should not be placed solely on the shoulders of rural surgeons. We believe it is best practice for the tertiary care hospital team to visit their community hospitals to better understand their resources, rather than the other way around. The Atrium Health National Surgical Quality Improvement Program Collaborative has been a valuable platform for making these connections for hospitals within our system and provides infrastructure for ongoing collaboration. Surgeons at tertiary care centers should also make themselves available for phone consultation for the complicated patient for whom a surgeon may simply need a second opinion. Not all “transfer calls” result in a transfer, and if both parties agree that the patient can continue to receive the same care at the local hospital that is often in his or her best interest.
Strengthening relationships with our community surgeons will allow surgeons at tertiary care centers to partner with them to optimally match patient needs to available resources. We truly appreciate our referring surgeons and thank them for the incredible work they do in serving our communities. Without their care on the front lines, we would not be able to provide the complex care and support to patients who need it most.