Statewide Transfer Coordination and Patient Transfer Rates Among Hospitals During Occupancy Stress

Mary E. Richert, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Guoqing Diao, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Alex Mancera, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Brittany Badesch, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Maniraj Neupane, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Roxana Amirahmadi, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Sadia H. Sarzynski, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Sarah Warner, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Joel S. Weissman, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Eric Goralnick, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Brian J. Franklin, Department of Emergency Medicine, Stanford University, Palo Alto, California.
Bruce J. Swihart, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
Lisa Villarroel, Arizona Department of Health Services, Phoenix.
John L. Hick, Hennepin Healthcare, University of Minnesota, Minneapolis.
Steven H. Mitchell, Department of Emergency Medicine, University of Washington, Seattle.
Parneet Kaur, Data Coordinating Center, University of Utah, Salt Lake City.
Benjamin Fisher, Data Coordinating Center, University of Utah, Salt Lake City.
Sameer S. Kadri, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.

Document Type

Journal Article

Publication Date

12-1-2025

Journal

JAMA network open

Volume

8

Issue

12

DOI

10.1001/jamanetworkopen.2025.46002

Abstract

IMPORTANCE: Some US states established state medical operations coordination centers (SMOCCs) during the pandemic to coordinate transfers and maximize care delivery when available beds were limited. Understanding their associations might inform their continued value in helping reduce delays and minimize strain during public health emergency conditions. OBJECTIVE: To examine the association of SMOCC establishment with adult interhospital transfers (IHTs) during pandemic surges. DESIGN, SETTING, AND PARTICIPANTS: This interrupted time series cohort study evaluated hospitalized adults (aged ≥18 years) from 8 US states. Data analysis was completed in March 2025. EXPOSURE: SMOCC establishment. SMOCC initiation was adjudicated through a published survey and inquiries with state health departments. MAIN OUTCOMES AND MEASURES: Outcome measures were immediate and long-term change in IHT by emergency medical services (EMS) agencies that continuously reported in the National EMS Information Systems database between June 1, 2020, and December 30, 2022. The inflection point (SMOCC establishment) was centered using relative dates while controlling for seasonality. Hospital occupancy stress was measured using daily hospital census and staffed bed counts and weighted by fixed bed capacity. Effect modification by increasing occupancy stress across study states was tested using an interaction term. Findings were validated in several subset analyses. RESULTS: Across the study's 8 states (Alaska, Colorado, Idaho, Maryland, North Carolina, Oregon, Utah, and Virginia), 441 709 transfers (median [IQR] age, 61.0 [44.0-73.0] years; 227 982 [51.6%] male) were analyzed, with 321 078 (72.8%) occurring after SMOCC establishment. SMOCC establishment was associated with an immediate increase (rate ratio [RR], 1.35; 95% CI, 1.05-1.74; P = .02) followed by a long-term decrease (RR, 0.94; 95% CI, 0.90-0.97; P < .001) in transfer rates. A significant increase in transfers per decile increase in occupancy stress was observed 40 weeks into SMOCC establishment (RR, 1.23; 95% CI, 1.06-1.42; P = .007). Findings were similar across transfers grouped by urbanicity, mode of transport, patient age, and acuity. CONCLUSIONS AND RELEVANCE: In this cohort study of 8 US states, pandemic initiation of a SMOCC was associated with an immediate increase in transfer rates between hospitals of approximately 35% after establishment and, after a potential lag, appeared to meet an increasing demand for transferring patients during surges. These results suggest that activating SMOCCs during large-scale public health emergencies might improve access to care and mitigate transfer gridlocks, but their utility during routine times warrants study.

Department

Biostatistics and Bioinformatics

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