Background: Interfacility transfers to tertiary centers are a critical mechanism for ensuring patients have access to advanced diagnostics and therapeutics. However, hospital occupancy now exceeds 75% nationally (Leuchter 2025), and high-capacity utilization has been associated with increased inpatient mortality (Sharma 2022). Timely transfers and appropriate resource matching are therefore essential. To address these challenges, Penn Medicine (PM) introduced ATP, a physician embedded within the capacity management center, to provide detailed clinical review and assist in real-time clinical and operational decisions. The ATP reviews accepted transfer requests, identifies appropriate in-network alternatives when tertiary care is not required, and prioritizes patients by clinical urgency while they await disposition.
Methods: A six-month pilot (March 27-September 29, 2025) was conducted at PM. Interfacility transfer requests (n=1053) were reviewed by ATPs. Each encounter was documented in a standardized database capturing origin, service line, intervention needed, and ultimate disposition. The ATP role operates 5 days (7AM-5PM) per week in collaboration with capacity management. Descriptive analyses summarized intervention categories, disposition changes, and changes in time from patient acceptance to bed arrival compared with baseline.
Results: ATPs initiated a change in disposition for 102 of the 1053 total transfer requests (9.7%). Among these, 25 (24%) were redirected to alternate in-network hospitals to optimize capacity; 26 (26%) were discharged from the referring hospital with expedited outpatient follow-up at PM; 12 (12%) had a level of care modification; and 39 (38%) were reassigned to an alternative service line or bed type. Following ATP implementation, the average and median times from acceptance to bed arrival decreased by 5.99 hours (a 29.9% reduction) and 1.69 hours (a 26.2% reduction), respectively, compared to baseline.
Conclusions: Embedded ATPs within health network capacity management centers can enhance interfacility transfer processes and optimize system flow. The ATP program ensures timely access to tertiary care while level loading institutional resources. Early data show measurable and meaningful reductions in transfer delays and improved alignment between patient needs and available capacity. Ongoing work will evaluate downstream impacts on length of stay, throughput, and patient outcomes as well as the possibility of expanding hours of coverage.