Trauma surgeon Anne Stey is haunted by the lives she couldn’t save.
While she was working a shift at a San Francisco hospital, a patient came in with a life-threatening heart emergency. The patient’s aorta had a hole. Without immediate care, they would bleed to death.
Her hospital could handle serious traumas like a gunshot wound or a car crash. But it didn’t have a heart surgeon or tools for a heart operation.
Stey and her colleagues spent hours keeping the patient stable and frantically calling nearby hospitals to see who could take them. Finally, a colleague contacted a heart surgeon at Stanford who eventually repaired the aorta.
“It becomes a frantic dig through everyone’s Rolodex: ‘Who do you know at this hospital?’ And there has to be a better way,” Stey said. She has worked in emergency rooms in New York, California and is now a trauma and critical care surgeon at Northwestern Memorial Hospital.
Stey wants to make transferring patients between hospitals simpler and faster, a fix she says will prevent deaths. She recently published research that found people in Illinois are dying while waiting to be transferred to trauma centers.
Her research found that up to 34% of critically injured patients showed up at a hospital not equipped to treat them and faced life-threatening delays while awaiting transfer to a trauma center.
The problem has gotten worse in Illinois, where Stey and her colleagues surveyed 64 health care workers from nine high-level trauma hospitals and three high-level pediatric trauma centers.
Their research found that some transfers were impacted by a lack of ambulances and trouble transferring patients’ full medical records.
“We go into this work because we want to help people,” she said. “It’s one of the most uncomfortable and disturbing feelings when there is a solution to help a patient, but I can’t do it.”
These deaths could be prevented with better coordination and communication, Stey said. That could include creating a real-time bed tracker and making it simpler for hospitals to share a patient’s full medical records.
“The idea to do the study came from experiencing this problem at both sending and receiving hospitals and seeing how incredibly common it is for transfers to take too long and be too difficult,” she said.
A potentially deadly delay
A smoother transfer process could have saved Yvonne Mosley’s life, an attorney representing her family told the Sun-Times.
In late October 2022, Mosley, 77, was taken to Little Company of Mary on the Far South Side. She had been dealing with significant health issues, including dementia, hypertension and diabetes. She spent the next two weeks in the hospital, said Shawn Barrett, Mosley’s family lawyer.
On Nov. 5, she woke up with a facial droop and struggled to communicate. She was moved to the intensive care unit, but doctors soon determined she needed advanced care they couldn’t provide.
They arranged an emergency transfer to Advocate Christ Medical Center two miles away. But it took five hours to move her.
Once she arrived at Christ that evening, a scan revealed a bleed in her brain. She underwent emergency surgery but never woke up. She died on Nov. 9.
“It’s inexcusable,” Barrett said. “Once they realized they couldn’t help her, that they knew she needed immediate care, why did it take five hours to transfer her?”
Barrett filed a lawsuit against Little Company of Mary on behalf of Mosley’s family. The hospital declined to comment on ongoing litigation.
‘No global understanding’
A patient might be transferred to another hospital for several reasons. Sometimes the hospital can’t treat a patient’s injury or health emergency. Other times, the hospital is overwhelmed and doesn’t have space or staff to care for them.
“This begins an arduous and stressful process, as the hospital tries to find a bed for a patient whose life is hanging in the balance,” Stey said.
Individual medical centers often operate as one big system given that patients tend to move between hospitals and clinics, she said.
“But there is no global understanding of what happens across that entire system,” Stey said. “There’s not a clear understanding between hospitals, and no one has been tasked with being responsible for managing these transfers.”
So it falls on the clinical teams taking care of patients, she said.
One care team Stey and her colleagues surveyed said they spent an entire eight-hour shift to get just one person from their ER to a suitable hospital.
“To spend an entire shift on one person is unsustainable,” she said. “What about everyone else they need to see and attend to?”
Stey encourages patients and their families to learn where the nearest trauma center is. The closest hospital might not be the best choice depending on the medical emergency. The Illinois Department of Public Health maintains a map of the Level I and II trauma centers for children and adults.
The state health department says a Level I trauma center provides all essential services in-house all the time and must always be staffed with a general or trauma surgeon. A Level II center provides some essential services all hours and must have a general or trauma surgeon available within 30 minutes.
Simple solutions
To improve patient transfers, Stey suggests Chicago and Illinois create a real-time hospital bed tracker, a system popularized during the COVID-19 pandemic.
The tracker would provide hospitals across the city and state real-time data on how many beds hospitals have and whether enough staff is available to treat an incoming patient.
“If they know the number of beds at other hospitals, the sending hospital can find a bed much faster,” Stey said.
Before the pandemic, the Chicago Department of Public Health developed a bed tracker as a part of an overall hospital preparedness program, Stey said. In case of a mass casualty event, for example, the bed counter would be used to determine which hospitals could manage a lot of patients at once and which ones couldn’t.
But during COVID-19, many hospitals didn’t rely on the data in the health department’s tracker because it was only updated once a day at 10 a.m., Stey said.
“Ten a.m. in an ER can be very different from 10 p.m. So they wouldn’t check it. It wasn’t reliable,” she said.
The city health department has been in “regular dialogue” with Stey about her work and ways to “improve Chicago’s hospital bed availability data,” a spokesperson told the Sun-Times.
But the city did not say whether the department is considering creating a transfer program. The department deferred to the Illinois Department of Public Health on any statewide efforts for a patient transfer center.
The state health department did not respond to requests for comment about whether a real-time bed tracker and transfer operation was possible.
Several states have centralized their hospital transport systems, including Minnesota, Arkansas, Washington and Oregon, Stey said.
While each state’s approach varies, Stey said the general idea is the hospital sending a patient calls one statewide phone number. The person answering has a real-time bed tracker for all the state’s hospitals. The operator then identifies the hospital with space and calls that hospital to see if they can take the patient.
The Oregon Medical Coordination Center, a state-funded collaboration between the Oregon Health Authority and regional hospitals, uses real-time data to help hospitals transfer patients when they lack capacity, according to its website. The 24/7 center finds beds in adult, pediatric and neonatal ICUs, obstetrics and pediatric and adult critical care.
“This takes the responsibility from the sending hospital who is also caring for that patient and others,” Stey said. “The operator is also an honest broker, they’re removed from the situation and not stressed out trying to provide lifesaving care.”
Digitally sharing a patient’s full medical record would also simplify the transfer process, Stey said. Some hospitals are still printing out a patient’s information or downloading it onto DVDs when transferring them.
This way, before the patient is moved, the receiving care team can at least look at that data to determine how to treat the patient, understand how sick the patient is and what they can do to prepare, she said.
“It’s also a lot less subjective, they’re able to parse out what is actually happening,” Stey said. “This also ensures data is not lost and establishes a shared understanding of what’s wrong with the person and how we can help them.”