By Dr. Annie Tsui, Chief Medical Officer, Neurology
High-reliability care depends on more than responding effectively when a patient needs care. It requires us to anticipate those needs, understand the resources available across the system, and create processes that consistently guide each patient to the most appropriate care setting.
One of our health system partners in the upper Midwest is especially intentional about this work. The system serves a very large catchment area that includes both urban and rural communities. Across that footprint, it operates an intricate hub-and-spoke model, with hospitals offering different levels of neurological and stroke care based on their local capabilities.
Access TeleCare has provided teleNeurology services across this system for many years. During that time, our program has grown alongside the health system and its communities. Most recently, that partnership has expanded to include a new approach that places our neurologists directly within the transfer decision-making process.
The goal is straightforward but incredibly important: Determine which patients can safely receive high-quality care in their local communities and which patients truly need to be transferred to a higher level of care.
One Health System, Many Different Care Settings
Large regional health systems are rarely uniform. One hospital may offer advanced stroke intervention, intensive care, and comprehensive inpatient neurology. Another may have the resources to treat many neurological conditions but lack certain subspecialty capabilities. A smaller rural hospital may primarily need immediate access to a neurologist when a patient arrives with stroke symptoms or another neurological emergency.
Each of those hospitals plays an important role in the regional care network. Each also requires a different level of specialty support.
One of the distinct advantages of Access TeleCare is our ability to tailor our telemedicine programs around those local needs.
Within this partner system, some hospitals rely on us for full, 24/7 emergency neurology coverage for stroke and non-stroke emergencies. Some also use teleNeurohospitalist services to provide inpatient consultations, continuity rounding, and neurological care from admission through discharge. Other care sites receive EEG support or emergency neurology coverage alone. At certain hospitals, our physicians share responsibility for the service line with the local neurology team, rotating coverage from week to week.
These models may look different from one hospital to another, but they support the same systemwide objective: making specialized neurological care available where and when patients need it.
Bringing Neurology Expertise to the Front End
Patient transfers are a constant and complex consideration for a health system with multiple hospitals and levels of care.
When a patient presents with a neurological condition, the decision focuses on whether the local hospital has the appropriate resources to safely and effectively manage that patient. If not, the team must identify an outside care source and coordinate the transfer. That decision can affect the patient’s treatment timeline, the receiving hospital’s capacity, ambulance availability, staffing, and bed utilization across the entire system.
Historically, the neurologist may become involved only after a transfer is underway or once the patient reaches the receiving facility.
The model we’ve deployed with this health system moves specialist input to the front end of the process.
Through the neurology transfer center program, our physicians provide clinical guidance while the transfer decision is being made. The neurologist can review the patient’s presentation, discuss the case with the referring team, and help determine the level of care the patient requires.
In some cases, that consultation may confirm that the patient needs to be transferred to a hospital with advanced neurological, neurosurgical, or interventional capabilities. In others, the neurologist may determine that the patient can be treated safely at the current hospital with virtual specialty support.
A transfer should never be avoided when it is clinically necessary. At the same time, transferring a patient who can be appropriately treated locally may separate that person from family and community support, introduce care delays, and consume limited capacity at a higher-acuity hospital.
By making neurology expertise available during the initial assessment, the health system can make more informed placement decisions based on the patient’s actual clinical needs.
Keeping Appropriate Care Local
Our goal, of course, is to keep patients in their local care communities whenever possible.
For the patient, receiving care locally often means remaining closer to family, avoiding the disruption of transportation to a distant facility, and continuing treatment within a familiar hospital. For the local care team, access to a neurologist provides the clinical support needed to manage cases that may otherwise have been transferred solely because specialty expertise was unavailable.
This approach also helps hospitals build confidence in their ability to care for neurological patients. Our neurologists do not simply provide a recommendation and leave the bedside team to carry it out alone. They collaborate with emergency physicians, hospitalists, nurses, and other on-site clinicians throughout the patient’s care.
Over time, those relationships help make neurological care a more integrated and sustainable part of the hospital’s clinical capabilities. As I have discussed previously, consistent, comprehensive neurology coverage can help hospitals treat more complex patients locally while strengthening the community’s trust in its local hospital.
Using System Resources More Judiciously
The transfer center program also supports thoughtful resource allocation across the full health system.
Higher-acuity beds, specialty teams, and transportation resources are finite. When neurologists help identify which patients truly need those resources, the system can preserve capacity for the patients who will benefit from it most.
At the same time, the program is not focused only on reducing outbound transfers. A strong regional care network must also be able to direct patients toward facilities with the right available capabilities. TeleNeurology can help a hospital retain appropriate patients while supporting the timely movement of patients who require more advanced care.
Effective transfer management is not about keeping every patient in place. It is about helping the right patient receive the right care at the right site.
Better clinical decisions at the front end can reduce unnecessary movement within the system, improve the use of specialized resources, and support care delivery that is both patient-centered and operationally responsible.
A Growing Partnership
What makes this transfer decision program especially meaningful to me is that it grew from a long-standing partnership.
We began by supporting specific neurology needs across individual hospitals. As the health system’s needs evolved, our services evolved with them—from emergency stroke response to inpatient neurology, EEG support, collaborative coverage with local physicians, and now transfer decision consultation.
This kind of growth is possible when telemedicine is treated as an integrated clinical partnership rather than a one-size-fits-all coverage solution. Our teleNeurology programs are designed to work within a hospital’s existing services and workflows, allowing virtual specialists and local clinicians to operate as one care team.
The transfer center program is a natural extension of that philosophy. It brings our neurologists into one of the health systems’ most consequential operational and clinical decisions: where a patient should receive care.
As we look back on the program’s development, we can see its impact across the care network. It gives clinicians earlier access to specialist guidance. It helps local hospitals care for appropriate patients with greater confidence. It supports more judicious use of higher-acuity resources. Most importantly, it helps patients receive care in the setting best equipped to meet their needs.
This is truly the type of innovative work our clinical team is passionate about. I’m deeply appreciative of this partner’s vision, and I am proud that Access TeleCare has the opportunity to help bring it to life.
