Developing a transfer center in a tertiary cancer center: streamlining access and communication to accommodate increasing demand for service.

Hospital-to-hospital transfers in a tertiary cancer center present an unusual set of problems involving a diverse group of acutely ill patients with highly specialized needs. The level and urgency of care required and the costs of providing optimal management often are exceedingly high. We present the administrative issues involved during a major revamping and streamlining of the Transfer Center at The University of Texas MD Anderson Cancer Center. The impetus for change included overuse of the emergency facility as a triage center for transferred patients, lack of adequate preadmission medical and financial screening of patients in anticipation of a transfer, a suboptimal level of physician-to-physician handoff communication, and insufficient protocols for prioritizing potential admissions and thus optimizing the institution's limited resources. During implementation of these revised policies, additional concerns were identified, including reluctance to modify established protocols and an inability to ensure the arrival of non-emergent transfer patients at our institution during daytime hours. Prioritizing admissions based on the degree of urgency and available resources required ongoing flexibility in accepting new concepts and ideas. The success of the project is documented in this report, as are suggestions for how other centers that experience similar challenging reorganizations can apply the lessons learned from our endeavors.