Improving Emergency Department Transfer Communication in Critical Access Hospitals

Sep 11, 2025

Communication in emergency departments (EDs) is vitally important, especially when a patient transfer takes place. In order to provide timely, accurate, and direct communication from one healthcare facility to another, certain elements need to be communicated and documented, which is called the Emergency Department Transfer Communication (EDTC).

Medicare Beneficiary Quality Improvement Program

EDTC is one of the measures within the Medicare Beneficiary Quality Improvement Program (MBQIP). Nationwide, Critical Access Hospitals (CAH) are held to quality improvement initiatives, or MBQIP, to improve patient care. The Center for Rural Health houses the North Dakota Medicare Rural Hospital Flexibility (Flex) Program, which oversees the North Dakota CAH Quality Network, which serves as a common place for North Dakota's CAHs to share best practices, tools, and resources related to providing quality of care.

Recently the North Dakota Flex Program saw challenges many CAHs were facing when it came to MBQIP measures, specifically the EDTC scores, and they developed a program designed to help hospitals raise their score on the measure.

Shared Goals

Five hospitals were invited to be part of a five-year cohort with the short-term goal of reaching 100% one of the eight EDTC elements they weren't currently meeting. The long-term goal is to reach 100% in all eight elements. And the program has seen success during the first year.

Anna Walter, Flex project coordinator, shared how the cohort has worked together and independently to achieve these goals. "From the time a provider decides a patient needs to be transferred, there are a series of steps that should be taken to ensure the facility the patient is being transferred to has all necessary communication available in a timely manner to continue that patient's care," she said.

Importance of Planning

The members of the group each had to develop a Plan-Do-Study-Act (PDSA), which Walter helped walk them through.

"The group has met quarterly for the first year," said Walter, "which included a lot of peer-to-peer discussions and sharing of resources. The first meeting was to identify challenges or barriers the facilities were experiencing that may be prohibiting them from achieving 100% in all eight EDTC elements. Some common challenges identified included travel staff not being orientated on EDTC and staff not fully documenting everything they did or collected in the medical record."

Walter also met with each facility individually, to look for ways efficiencies could be found, since every ED is different.

"The PDSA allowed the facility to work toward a specific area of improvement. Once those were completed, we also worked on process mapping the EDTC process within their facility. This is a visual way to understand the different steps that take place in an ED once a patient transfer begins, similar to a flow chart. This has been a great tool for them to share with all ED employees the inconsistencies that were identified in their current workflow and what changes needed to be made in order to improve the process and communication."

Seeing Success

The second year will include continuing to monitor the scores and see if any additional follow-up is needed. After that, more monitoring will take place and Walter is hopeful the scores will continue to increase.

"We have already seen short-term success with the members of the cohort. All five facilities saw improvement in their EDTC scores, and four of the five reached their short-term goal of 100% in at least one element. This has been a great model and way for Flex to identify how additional support can make a difference in Quality measures."