Right-Sizing Care: Transferring Lower-Acuity Patients from an Academic Medical Center to a Community Hospital

Abstract

Summary Academic medical centers (AMCs) are well suited to provide tertiary and quaternary care, with subspecialty physicians and advanced diagnostics and therapeutics. They accept transfer patients with complex needs from community hospitals. However, AMCs rarely transfer lower-acuity patients to community hospitals, even when the AMC has high occupancy rates and unmet demand for beds. The authors describe a program to transfer patients who present to the ED of an AMC, University of California, San Francisco (UCSF), to a community hospital, St. Mary’s Medical Center (SMMC). By diverting lower-acuity admissions, the program aims to reduce ED congestion and boarding time, improve inpatient capacity at UCSF, and match patient acuity with site of care. The program has created thousands of patient bed-days at UCSF while increasing patient volume and bed utilization at SMMC. It has also faced logistical and coordination challenges and has been tested by the Covid-19 pandemic.