Background: Hospital systems face increasing challenges in managing interfacility transfers and direct admissions, particularly in large, multi-hospital networks where capacity and capability vary across regions. Inefficient transfer processes can lead to care delays, inappropriate placement, and strain on system resources. To address these issues, our healthcare system created a virtual hospital medicine (VHM) program, leveraging technology and centralized expertise to optimize patient flow. A key component of VHM is the Administrative Triage Clinician (ATC) program, launched in July 2024, which aims to streamline interfacility transfers and direct admissions across 15 hospitals in three regions of our state.
Purpose: The ATC program was designed to improve patient safety, enhance system-wide capacity management, and ensure patients are directed to the most appropriate level of care and facility. Previously, local hospitalists managed transfer and direct admission requests during clinical shifts without knowledge of hospital or system capacity. By centralizing triage decisions with trained hospitalists, the program sought to reduce system inefficiencies and support equitable resource allocation.
Description: The ATC program integrates clinical expertise with operational oversight to evaluate transfer and admission requests received through the health system’s transfer center. Nine hospitalists function as ATCs, evaluating an average of 24 cases (range: 9-44) per 12-hour shift for clinical appropriateness, urgency, and system capacity, considering floor-, intermediate-, and intensive care-level beds across multiple facilities. They also assess hospital-specific capabilities to match patient needs with available resources. Transfer center staff receive case requests and relay them to ATCs via Epic secure chat. ATCs discuss the case with requesting providers via recorded phone calls facilitated by transfer center staff. For accepted medicine cases, ATCs document a standardized “Transfer Acceptance Note” in Epic and use secure chat to provide local hospitalists handoff. Case requests include inter-hospital transfers, direct admissions from emergency departments, and clinic-based requests. ATCs employ capacity dashboards for real-time insights and adhere to standardized protocols for decision-making. Implementation required significant cultural change, iterative feedback, and process refinement, including optimizing acceptance notes, handoff templates, and hospital capability documents. Key challenges included balancing consultant involvement, managing planned versus emergent admissions, and mitigating longer call center case times. The program also revealed systemic gaps, prompting inpatient e-consult pilots and revisions to planned admission workflows. Local hospitalists reported fewer interruptions to clinical duties.
Conclusions: The ATC program demonstrates that embedding hospitalist-led triage within a system virtual hospital medicine framework can enhance patient safety, optimize resource utilization, and improve interfacility transfer efficiency. Early implementation has revealed opportunities for broader system improvements, including streamlined planned admissions and enhanced specialty access. By fostering communication, standardization, and operational agility, this innovation offers a scalable model for health systems seeking to manage complex transfer networks while maintaining high quality, patient-centered care.