Adapting to Capacity Pressures: A New Era for Patient Flow and Transfer Models
Main Article Content
Abstract
Patient transfers between acute care hospitals (inter-hospital transfer, IHT) occurs commonly, most often to provide specialized care unavailable at the index hospital. However, modern capacity constraints within the healthcare system have resulted in novel models of care that impact IHT. In this manuscript, we explore several models of patient transfer management that have evolved in response to current capacity constraints including repatriation and lateral patient transfers as newer care models to improve load-balancing across a healthcare system, and novel care models such as tele-consult services as alternatives to transfer.
Article Details
How to Cite
MUELLER, Stephanie K..
Adapting to Capacity Pressures: A New Era for Patient Flow and Transfer Models.
Medical Research Archives, [S.l.], v. 13, n. 6, june 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6685>. Date accessed: 15 july 2025.
doi: https://doi.org/10.18103/mra.v13i6.6685.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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10.1161/CIRCOUTCOMES.110.957993
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10.1016/j.ahj.2008.01.033
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8. The Emergency Medical Treatment and Active Labor Act, as established under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 USC 1395 dd) and 42 CFR 489.24; 42 CFR 489.20 (EMTALA regulations).
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14. Usher MG, Tignanelli CJ, Hilliard B, et al. Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation. J Patient Saf. Jun 1 2022;18(4):287-294. doi:10.1097/P TS.0000000000000916
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16. Kunz SN, Dukhovny D, Profit J, Mao W, Miedema D, Zupancic JAF. Predicting Successful Neonatal Retro-Transfer to a Lower Level of Care. J Pediatr. Feb 2019;205:272-276 e1. doi:10.1016/j.jp eds.2018.09.010
17. Lynch TM, Jung AL, Bose CL. Neonatal back transport: clinical outcomes. Pediatrics. Dec 1988; 82(6):845-51.
18. Safavi KC, Koehler A, Mathews N, et al. Impact of a Repatriation Program Between Quaternary and Community Hospitals. Jt Comm J Qual Patient Saf. Nov 2023;49(11):592-598. doi:10.1016/j.jcjq.2 023.07.004
19. Mueller SK. Repatriation of Transferred Patients: A Solution for Hospital Capacity Concerns? Jt Comm J Qual Patient Saf. Nov 2023;49(11):581-583. doi:10.1016/j.jcjq.2023.08.005
20. Franklin BJ, Mueller SK, Bates DW, Gandhi TK, Morris CA, Goralnick E. Use of Hospital Capacity Command Centers to Improve Patient Flow and Safety: A Scoping Review. J Patient Saf. Sep 1 2022;18(6):e912-e921. doi:10.1097/PTS.00000000 00000976
21. Franklin BJ, Yenduri R, Parekh VI, et al. Hospital Capacity Command Centers: A Benchmarking Survey on an Emerging Mechanism to Manage Patient Flow. Jt Comm J Qual Patient Saf. Apr 2023;49(4):189-198. doi:10.1016/j.jcjq.2023.01.007
22. Vazquez JR, Clements J, Hendricks M, Pagali S. 5 Best Practices and Resources for Interhospital Transfers. The Hospitalist: Society of Hospital Medicine; 2025.
23. Dolan E, Johnson N, Kepler T, et al. Hospital load balancing: A data-driven approach to optimize ambulance transfports during the COVID-19 pandemic in New York City. Available at SSRN 4094485. 2022;
24. Fernandes-Taylor S, Yang Q, Yang DY, Hanlon BM, Schumacher JR, Ingraham AM. Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients. J Trauma Acute Care Surg. Apr 1 2023;94(4):592-598. doi:10.1097/TA.00000000000 03789
25. Mueller SK, Harrison JD, Yu A, Kelly C, Leykum LK. Re-envisioning interhospital transfer: A qualitative study exploring alternatives to transfer. J Hosp Med. May 29 2025;doi:10.1002/jhm.70083
26. Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US. JAMA Intern Med. Mar 1 2021;181(3):388-391. doi:10.1001/jamainter nmed.2020.5928
2. Mehta RH, Stalhandske EJ, McCargar PA, Ruane TJ, Eagle KA. Elderly patients at highest risk with acute myocardial infarction are more frequently transferred from community hospitals to tertiary centers: reality or myth? Am Heart J. Oct 1999;138 (4 Pt 1):688-95. doi:S0002870399003579 [pii]
3. Iwashyna TJ, Kahn JM, Hayward RA, Nallamothu BK. Interhospital transfers among Medicare beneficiaries admitted for acute myocardial infarction at nonrevascularization hospitals. Circ Cardiovasc Qual Outcomes. Sep 2010;3(5):468-75. doi:CIRCOUTCOMES.110.957993 [pii]
10.1161/CIRCOUTCOMES.110.957993
4. Roe MT, Chen AY, Delong ER, et al. Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals. Am Heart J. Jul 2008;156(1):185-92. doi:S0002-8703(08)00138-5 [pii]
10.1016/j.ahj.2008.01.033
5. Sokol-Hessner L, White AA, Davis KF, Herzig SJ, Hohmann SF. Interhospital transfer patients discharged by academic hospitalists and general internists: Characteristics and outcomes. J Hosp Med. Nov 20 2015;doi:10.1002/jhm.2515
6. Iwashyna TJ, Christie JD, Moody J, Kahn JM, Asch DA. The structure of critical care transfer networks. Med Care. Jul 2009;47(7):787-93. doi:10.1097/MLR.0b013e318197b1f5
7. Mueller SK, Shannon E, Dalal AK, Schnipper JL, Dykes P. Patient and Physician Experience with Inter-Hospital Transfer: A Qualitative Study. J Patient Saf. 2018;In press
8. The Emergency Medical Treatment and Active Labor Act, as established under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 USC 1395 dd) and 42 CFR 489.24; 42 CFR 489.20 (EMTALA regulations).
9. Iwashyna TJ. The incomplete infrastructure for interhospital patient transfer. Crit Care Med. Aug 2012;40(8):2470-8. doi:10.1097/CCM.0b013e3182 54516f 00003246-201208000-00027 [pii]
10. Nguyen KT, Lee TM, Mueller SK. Multi-Institution Survey of Accepting Physicians' Perception of Appropriate Reasons for Interhospital Transfer: A Mixed-Methods Evaluation. J Patient Saf. Apr 1 2024;20(3):216-221. doi:10.1097/PTS.0000000000 001203
11. Contreary K, Chatrath S, Jones DJ, Cohen G, Miller D, Rich E. Consolidation And Mergers Among Health Systems In 2021: New Data From The AHRQ Compendium. Health Affairs Forefront. Health Affairs; 2023. Accessed May 9, 2025.
https://www.healthaffairs.org/content/forefront/consolidation-and-mergers-among-health-systems-2021-new-data-ahrq-compendium
12. Broman K, Richman J, Ross E, Zengul F, Weech-Maldonado R, Bhatia S. Hub and spoke framework for study of surgical centralization within United States health systems. Am J Surg. Oct 2023; 226(4):524-530. doi:10.1016/j.amjsurg.2023.05.006
13. Carroll C, Euhus R, Beaulieu N, Chernew ME. Hospital Survival In Rural Markets: Closures, Mergers, And Profitability. Health Aff (Millwood). Apr 2023;42(4):498-507. doi:10.1377/hlthaff.202 2.01191
14. Usher MG, Tignanelli CJ, Hilliard B, et al. Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation. J Patient Saf. Jun 1 2022;18(4):287-294. doi:10.1097/P TS.0000000000000916
15. Attar MA, Lang SW, Gates MR, Iatrow AM, Bratton SL. Back transport of neonates: effect on hospital length of stay. J Perinatol. Nov 2005;25 (11):731-6. doi:10.1038/sj.jp.7211391
16. Kunz SN, Dukhovny D, Profit J, Mao W, Miedema D, Zupancic JAF. Predicting Successful Neonatal Retro-Transfer to a Lower Level of Care. J Pediatr. Feb 2019;205:272-276 e1. doi:10.1016/j.jp eds.2018.09.010
17. Lynch TM, Jung AL, Bose CL. Neonatal back transport: clinical outcomes. Pediatrics. Dec 1988; 82(6):845-51.
18. Safavi KC, Koehler A, Mathews N, et al. Impact of a Repatriation Program Between Quaternary and Community Hospitals. Jt Comm J Qual Patient Saf. Nov 2023;49(11):592-598. doi:10.1016/j.jcjq.2 023.07.004
19. Mueller SK. Repatriation of Transferred Patients: A Solution for Hospital Capacity Concerns? Jt Comm J Qual Patient Saf. Nov 2023;49(11):581-583. doi:10.1016/j.jcjq.2023.08.005
20. Franklin BJ, Mueller SK, Bates DW, Gandhi TK, Morris CA, Goralnick E. Use of Hospital Capacity Command Centers to Improve Patient Flow and Safety: A Scoping Review. J Patient Saf. Sep 1 2022;18(6):e912-e921. doi:10.1097/PTS.00000000 00000976
21. Franklin BJ, Yenduri R, Parekh VI, et al. Hospital Capacity Command Centers: A Benchmarking Survey on an Emerging Mechanism to Manage Patient Flow. Jt Comm J Qual Patient Saf. Apr 2023;49(4):189-198. doi:10.1016/j.jcjq.2023.01.007
22. Vazquez JR, Clements J, Hendricks M, Pagali S. 5 Best Practices and Resources for Interhospital Transfers. The Hospitalist: Society of Hospital Medicine; 2025.
23. Dolan E, Johnson N, Kepler T, et al. Hospital load balancing: A data-driven approach to optimize ambulance transfports during the COVID-19 pandemic in New York City. Available at SSRN 4094485. 2022;
24. Fernandes-Taylor S, Yang Q, Yang DY, Hanlon BM, Schumacher JR, Ingraham AM. Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients. J Trauma Acute Care Surg. Apr 1 2023;94(4):592-598. doi:10.1097/TA.00000000000 03789
25. Mueller SK, Harrison JD, Yu A, Kelly C, Leykum LK. Re-envisioning interhospital transfer: A qualitative study exploring alternatives to transfer. J Hosp Med. May 29 2025;doi:10.1002/jhm.70083
26. Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US. JAMA Intern Med. Mar 1 2021;181(3):388-391. doi:10.1001/jamainter nmed.2020.5928