Connect to Capacity: Improving the Process for Patients Referred to MGH

Finding new and innovative ways to address the hospital’s ongoing, daily capacity challenges is the goal of many staff throughout the MGH. One such dedicated problem-solver is hospitalist Amber Moore, MD, director of Inpatient Medicine in the Department of Medicine, who is working to improve the process of patients seeking to transfer in from other care facilities.

“It sounds shocking, but only about 25% of patients we are called about ultimately are transferred into MGH,” says Moore. “In an ideal world, we would say ‘Come in’ and we would help everyone. But that’s not the reality we live in.”

Moore oversees the MGH Medical Officer of the Day program, a group of about 20 core physicians working on the frontlines to combat the near constant capacity challenges. The Medical Officer of the Day is the first MGH touchpoint for all outside hospital transfer requests to the Department of Medicine; they help decide where the patient needs to be clinically.

“Capacity is getting increasingly harder,” Moore says. “The ED and Department of Medicine are at the sharp edge, but it’s a hospitalwide problem. Our goal is to ensure equitable access to the care we can provide. There are many voices involved in the deciding who comes to MGH from other institutions. Because of that, establishing standard, dynamic protocols and having them agreed upon is extremely important. Without them there is too much variability; you lose the ability to give patients access to care in an equitable way.”

The Medical Officer of the Day evaluates the patient’s medical history, the issues they are facing, and the treatment they need at MGH. Often, the most complicated cases are transplant patients.

“In recent years there has been a significant increase in outside hospitals requesting to transfer patients to MGH for liver transplant evaluation,” says Emily Bethea, MD, medical director of the Mass General Brigham Liver Transplant Program. “It’s incredibly challenging to tease out a patient’s liver transplant candidacy when they are not already an MGH patient. Dr. Moore has been critical initiating meetings between hepatology, the Medical Officer of the Day program and patient access to develop and implement a set of protocols to optimize this very complex triage process.”

In 2022, MGH performed 95 liver transplants. Of those, 48% required assistance from the Medical Officer of the Day and partnership with hepatology to triage and successfully transfer.

“Of the hundreds of transfer requests in 2022, the improved triage process spearheaded by Dr. Moore allowed us to get in higher priority patients and provide life-saving transplants, with better overall outcomes,” Bethea says.

The work is challenging, far reaching and effective. Medical Officers of the Day work in parallel with the MGH Capacity Center and the MGB Patient Transfer and Access Center, resulting in many staff throughout the system working tirelessly to solve the ongoing capacity challenges.

“A good day for me is when it feels like all service lines are contributing and collaborating to provide the best care,” says Moore. “I take a lot of energy and strength from that. Working with so many motivated, competent, and engaged people who really care—that keeps me going.”