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Rural Emergency Department Transfer Communication

Rural Emergency Department Transfer Communication – Resources >


A National Quality Forum endorsed measure is available for hospitals to evaluate communication for transitions of care during emergency department (ED) transfers.

This ED transfer communication measure is particularly relevant for critical access hospitals (CAHs), and is included in the Medicare Beneficiary Quality Improvement Project (MBQIP). Starting fall 2014, CAHs nationwide can collect and submit the measure. MBQIP is a program of the Health Resources and Services Administration (HRSA) funded Office of Rural Health Policy’s (ORHP) Medicare Rural Hospital Flexibility Program (Flex).

Appropriate measures are needed to evaluate care in rural hospitals

Nationally, all large hospitals are required to publicly report a set of core measures indicating their performance in providing quality care. Many of the publicly reported measures are not relevant to the low-volume of services provided by CAHs. Low volumes results in unreliable data and some measures are for services not provided at CAHs.

While emergency care is important in all hospitals, the emergency department is particularly important in rural hospitals where the distance to urban tertiary care centers makes the effective triage, stabilization, and transfer of patients with the necessary and appropriate information of life or death importance. ED transfer communication measures allow the acute care safety net facilities to show how well they carry out their important stabilize-and-transfer role for rural residents. Minnesota requires quality reporting of critical access hospitals. CAHs in other states also may want to measure their own performance in providing quality care.

The ED transfer communication measures (EDTC) were originally developed by Stratis Health and the University of Minnesota Rural Health Research Center and were originally endorsed by the National Quality Forum in 2007.

ED Transfer Communication Special Innovation Project

Stratis Health led a one-year national special innovation project funded by the Centers for Medicare & Medicaid Services for critical access hospitals in eight states to improve transitions of care during ED transfers (August 2013 - July 2014).

Stratis Health supported eight Medicare Quality Improvement Organizations, working collaboratively with their state Medicare Rural Hospital Flexibility Program (Flex) offices, to train CAHs to collect and report seven composite ED transfer communication measures, identify gaps and opportunities for improvement, and begin planning to improve the transfer communication process and results. States included Iowa, Maine, Missouri, Nebraska, Oklahoma, West Virginia, Wisconsin, and Wyoming.

Participating CAHs abstracted medical records to collect data on the EDTC measures. CAHs submitted data through their QIOs to Stratis Health for benchmarking with other participating facilities.

Critical access hospitals improved process measures—56% relative improvement rate

“We want to look at measures that impact a larger number of our patients,” said Maureen Bruce, quality director, Moundview Memorial Hospital & Clinics, a CAH in Friendship, Wisconsin. “For us, that can be transfers, sometimes in a life or death situation.”

Participating CAHs increased their percentage of medical records meeting all of the EDTC data elements over the course of the project from 28.26 to 44.13 percent—for a relative improvement rate of 56 percent.

The hospitals used the results to develop and implement improvements focused on better documentation and communication processes.

Rural hospitals were trained to collect information on emergency department transfer communication, and use the data to improve quality of care, safety, and outcomes for patients transferred from their emergency departments.

Emergency Department Transfer Communication - Special Innovation Project Final Summary Report (15-page PDF)