Background: The availability of beds within healthcare systems has been stressed during each wave of the COVID-19 pandemic. Healthcare systems with tertiary hospitals have had increasing patient volumes and face limitations of specialized urgent (e.g., ECMO) and routine (e.g., Percutaneous Coronary Intervention) functions during critical inpatient surge volumes. Reserving the limited capacity at a tertiary [...]

Background: Emergency Department (ED) overcrowding and lack of hospital bed capacity are pervasive problems made worse by the Covid-19 pandemic. Bed capacity is a significant concern at Academic Medical Centers (AMCs), as patients depend upon AMCs for specialized in-hospital care not available at other regional hospitals. Bed capacity shortage is acutely felt at rural AMCs, [...]

Background: Hospital admissions at a tertiary care hospital occurs mostly by two routes: 1) through the Emergency Department (ED), and 2) through Transfer center. Several perceptions exist about transfer patients being more complex, and association with worse outcomes, or similar outcomes as compared to ED admits, and hence need for optimization of transfer decision and [...]

Background: Interhospital transfers are shown to be associated with increased length of stay (LOS), mortality, and discharge to facility.[1,2] Delirium has been associated with similar outcomes.[3] Our prior data showed that interhospital transfers had 1.91 times the risk of delirium when compared to ED admissions. We hypothesized that an interaction between admission source, namely interhospital [...]

Background: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care, such as errors in communication and gaps in information transfer. In our prior work evaluating IHT to general medical (GMS), cardiology, oncology and ICU services at an 800-bed tertiary care referral hospital, we found that in 37% [...]

Background: Tertiary hospitals and academic medical centers often operate near full capacity while smaller community hospitals have difficulty filling open beds. At our institution, a program was set up to transfer lower acuity patients needing admission from the emergency department of an academic medical center to a community partner hospital for direct admission. This and [...]

Background: Transitions of care, including Inter-Hospital Transfers (IHT), are known to be a period of elevated risk in patient care. Patients who are transferred via the IHT process face a higher inpatient mortality rate than patients who are not admitted via the IHT process1 as well as higher costs, longer length of stay, and lower [...]

Background: Transitions of care from one service to another are a precarious time with risk of adverse events, medical errors, and clinician dissatisfaction. Every handoff involves transferring information and responsibility for a patient from one physician to another. The appropriateness of transfer is critical to safe patient care. The transfer process from an intensive care [...]

Case Presentation: A 35-year-old female with tobacco use disorder presented to the emergency department with three months of recurrent fevers, non-productive cough, and dyspnea on exertion. She was initially seen by her primary care physician for these symptoms in the context of multiple sick contacts and was treated empirically for streptococcal pharyngitis with amoxicillin. Due [...]

Background: The availability of beds within healthcare systems has been stressed during each wave of the COVID-19 pandemic. Healthcare systems with tertiary hospitals have had increasing patient volumes and face limitations of specialized urgent (e.g., ECMO) and routine (e.g., Percutaneous Coronary Intervention) functions during critical inpatient surge volumes. Reserving the limited capacity at a tertiary [...]