Ep 49: What Happens When You Replace the Fax Machine with Shana Palmieri

Rachel speaks with Shana Palmieri, Chief Clinical Officer and co-founder of XFERALL (pronounced Transfer-all) , a real-time patient transfer and care coordination platform that is replacing one of the most broken processes in behavioral health — the psychiatric placement referral.   Shana spent years as the Director of Behavioral Health Services at George Washington University Hospital in Washington, D.C., where she watched something that would change the direction of her career. Patients in psychiatric crisis sitting in overwhelmed emergency departments for hours, sometimes days, while her team of highly trained clinical social workers spent the majority of their time making phone calls and sending faxes trying to find them a placement. She co-founded XFERALL to solve that problem directly.   The platform works by replacing the fragmented, paper-based referral process with a real-time digital system. A clinician enters basic patient information, the platform geolocates available, clinically matched facilities across the continuum of care, and within seconds the clinician knows which facilities have a bed and can accept the patient. XFERALL's median response time across the platform is 15 seconds. One county in California cut its average psychiatric wait time from more than two hours to 17 minutes. The national average for psychiatric placement is seven to eight hours or more.   The conversation also goes deep on AI — specifically where Shana believes it belongs in behavioral health and where it does not. She draws a clear line between using AI as an operational tool to reduce administrative burden, surface critical clinical information, and connect a fragmented system, versus using it to make clinical decisions or predict risk in ways that could strip patients of their rights. Her framework is one of the clearest articulations of responsible AI use in behavioral health we have heard on this show.   Resources Mentioned:   Articles Referenced: Children in a Mental Health Crisis Can Spend Days in the ER Waiting for Treatment — NPR (August 2025): https://www.npr.org/sections/shots-health-news/2025/08/15/nx-s1-5502689/pediatric-mental-health-er-boarding-jama-health-forum AI in the Mental Health Care Workforce Is Met with Fear, Pushback, and Enthusiasm — NPR (April 2026): https://www.npr.org/2026/04/07/nx-s1-5771707/mental-health-care-workforce-artificial-intelligence-ai XFERALL Expands Real-Time Patient Transfer Platform in Southern California — PR Newswire (February 2026): https://www.prnewswire.com/news-releases/xferall-officially-expands-real-time-patient-transfer-platform-in-southern-california-after-already-seeing-success-in-the-state-302689675.html   Connect with Shana Palmieri: XFERALL: https://www.xferall.com   Connect with The Mental Health Evolution: Website: https://www.traumaspecialiststraining.com/mental-health-evolution-podcast Instagram: /thementalhealthevolution/ LinkedIn: /the-mental-health-evolution Facebook: /TheMentalHealthEvolution   Music by Zach Harrison