Hospital transfers across U.S. regions to address the “space” shortage in a pandemic: A public good

The novel coronavirus disease 2019 (COVID-19) pandemic has made hospitals everywhere dust off and update, or feverishly write, pandemic preparedness and response plans to accommodate, among other challenges, surges of acute care patients above their local norms. Naturally, hospitals look to expand capacity within their own footprint first, by canceling elective care and expediting discharges, maximizing utilization of existing licensed beds, and opening new beds in both clinical and nonclinical areas. When that is not enough, or often in parallel, hospitals may look locally or regionally for assistance in the form of diverting or transferring patients to other hospitals, either those with normally lower acuity or those that are not facing a simultaneous surge. That approach—analogous to the routine practice of packed emergency departments temporarily diverting ambulances to nearby hospitals—works far better for a localized disaster that may heterogeneously impact hospitals in relative close proximity, leaving clear transferring (without capacity) and receiving (with capacity) hospitals. During a pandemic the scale of COVID-19, however, this approach can break down when an entire region peaks together, and local transfer acceptance capacity evaporates .

In this issue of Clinical Infectious Diseases, Michelson and colleagues put forward a scaled-up approach to this transfer paradigm looking instead at inter-region transfers—from one part of the United States to another—as a method to expand bed capacity, or more accurately load-balance, on a national scale. Their manuscript reports a sophisticated simulation study to assess specifically how transfers of patients between different regions of the country could alleviate hospital and intensive care unit (ICU) bed shortfalls during a pandemic, using a projected, continued COVID-19 pandemic as the use case. They report that in simulation, in all scenarios except the highest volume ICU scenario, inter-region transfers, with mean transfer distances upward of 300 miles, could fully resolve any bed shortages. This study has a number of notable strengths: it is of vital importance for the ongoing pandemic and future threats; it takes a sophisticated and interesting simulation approach; and it uses national data to create a full picture of the US healthcare infrastructure under study.

National Heart, Lung, and Blood Institute ( NHLBI)
Agency or Healthcare Research and Quality (AHRQ)