Evaluation of a Clinical Expeditor on Effective Hospital Repatriation

Patients who undergo interhospital transfer (IHT) from a referring facility to a facility that provides higher levels of care often experience increased length of stay (LOS) compared to patients who are admitted via other points of entry. Repatriation, the act of transferring a patient back to their referring facility after tertiary needs are met, is a method used to improve throughput and access and to ensure that patients receive the appropriate level of care. At an academic tertiary medical center, a nurse-led clinical expeditor role was developed to aid in standardization of the repatriation process. The purpose of this project was to evaluate the impact of the clinical expeditor role.

For this retrospective analysis, charts were reviewed for patients who underwent IHT from January 2022 to May 2025. Data were evaluated using statistical process control charts to identify special cause variation after role implementation.

After the clinical expeditor role was implemented in September 2023, there was a 104.4% increase in the average number of patients who were successfully repatriated each month, from 5.45 (standard deviation [SD] 3.71) to 11.14 (SD 5.10). For patients who underwent IHT, average LOS at the academic tertiary medical center decreased 16.0% from 13.06 (SD 1.49) to 10.97 (SD 0.72) days, although other environmental factors likely also contributed to this reduction, as LOS began to decrease approximately 6 months prior to implementation of the clinical expeditor role. Due to successful repatriation, the medical center saw a 100.2% increase in bed days saved between the baseline (1,735 days) to postimplementation period (3,473 days), allowing beds to be made available to other patients in need of tertiary-level care.

This evaluation supports the use of a clinical expeditor to assist in repatriation efforts as an effective strategy to reduce barriers to transfer and improve throughput.