SHM Converge Scientific Abstract ePoster Gallery-Multifaceted Approach to Increasing Transfers From a Large Academic Medical Center to an Affiliate Community Hospital

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This project describes a hospitalist-led effort at a large academic medical center (AMC) to increase transfers to an affiliate community hospital (CH) in order to reduce emergency department crowding and improve system capacity. The initiative addressed three main barriers: limited CH resources, inconsistent eligibility criteria, and inefficient transfer workflows.<br /><br />To expand capacity, the team first mapped available CH services and reviewed recent ED admissions to identify the highest-yield investments. This led to increased hospitalist admitting capacity at the CH, expanded neurology, gastroenterology, and psychiatry consult coverage, virtual neurosurgery consultation, and improved access to diagnostics and procedures such as interventional radiology, stress testing, and CT imaging.<br /><br />Second, the team refined transfer eligibility by reviewing ineligible cases and documentation, developing clearer triage protocols, and adding a transfer center–embedded triage hospitalist. They also created a mandatory training program and knowledge repository to standardize decision-making, especially for services unavailable at the CH such as hepatology, advanced endoscopy, and step-down care.<br /><br />Third, they redesigned transfer workflows across multiple systems by coordinating with bed control, nursing leadership, and financial clearance teams, standardizing communication about capacity across campuses, and training emergency department case management staff to obtain assent more efficiently.<br /><br />Results showed a substantial increase in transfer volume. In the 52 weeks before the intervention, the AMC averaged 10.5 transfers per week. After implementation, this increased to 23.5 per week, with peaks of 62 transfers in one week and 206 in one month.<br /><br />The authors conclude that successful AMC–CH partnerships require aligned resources, explicit eligibility criteria, and standardized workflows. This initiative effectively doubled transfer volume and demonstrates how hospitalists can drive system-level strategies to improve access and expand hospital network capacity.

Asset Subtitle

Neal A. Tambe

Meta Tag

Author List Bradley Monash, Lauren Linett, Lukejohn W. Day, Michelle S. Mourad, Neal A. Tambe, Rashmi Manjunath

Category Innovations

Concept Patient Transfer

Concept Transfer Capacity

Concept Community Hospital

Concept Resource Expansion

Concept Triage Protocol

Distinguished Non-Finalist

Presenter Organization UCSF Division of Hospital Medicine

Presenting Author Neal A. Tambe

Track Transitions of Care

Keywords

hospitalist-led transfer initiative

academic medical center

community hospital

emergency department crowding

hospital transfer volume

capacity expansion

triage protocols

transfer workflows

affiliate hospital partnership

system-level capacity

Patient Transfer

Transfer Capacity

Community Hospital

Resource Expansion

Triage Protocol