June 18, 2020

How Arizona Health Systems Went From Competitors to Collaborators to Load-Balance COVID-19 Resources

Written by Charley Larsen, RN, MSN, MBA, CNML, NE-BC, RN Senior Director, Banner Health Transfer Services

Fierce Healthcare — June 17, 2020 — Many types of businesses in Arizona in mid-May began the process of reopening after weeks of COVID-19-related closures. As a result, state officials and health system leaders prepared for the worst, but hoped for the best as we braced for a possible patient surge.


Now, as of this writing in mid-June, COVID cases and deaths are on an exponential growth curve in the state.


However, Arizona is better prepared than most other states that have also begun to reopen their economies. That’s because in April, Arizona’s Department of Health Services (ADHS) created a first-of-its-kind regional access center that any physician statewide can call to transfer a patient with COVID-19 from their hospital to one of the dozen or so health systems admitting patients in need of critical care.


The regional access center, dubbed the Arizona Surge Line, launched on April 21. As of this writing, the service is managing an average of 22 to 26 patient transfers per day, with the capacity to handle more than 100 per day if needed.


How the state got to this point is a story of foresight, fortunate circumstances, and hard work.


Most of all, it is an inspiring example of how healthcare industry competitors can put their market share and financial concerns aside to collaborate—even though we have all been devastated by a downturn in patient volume. Together, we aligned resources and found solutions to ensure every patient with COVID-19 receives the right level of care without delay, while also protecting the health and safety of frontline clinicians by ensuring adequate access to PPE.


Learnings from other states

As COVID-19 spread from the U.S. coasts, officials from the ADHS recognized that a statewide patient load-balancing system would be required, whether those hospitals were across town from each other or in distant parts of the state.


They had witnessed what had happened in New York City where some hospitals were overwhelmed with patients, while other healthcare facilities went largely unused.


To drive the statewide service, ADHS leaders knew that they needed technology that could provide real-time visibility into bed capacity and specialist and ventilator availability across the state’s 100-plus hospitals. This was a significant undertaking given that a statewide hub like this had never been attempted before anywhere in the country.


As director of transfer services for Banner Health, the largest health system in the state, I had been in contact with ADHS officials about the anticipated surge. After we discussed what resources would be needed statewide, Banner generously allowed me to temporarily step aside from my health system duties to lend my time and expertise to the initiative as an in-kind donation.


Rapid ramp-up

Within a few days of the first conversations about the Surge Line initiative, leaders from every major health system and hospital in the state were on a conference call together to learn more about the ADHS plan and why we needed to combine resources across the state to benefit patients.


Fortunately, everyone agreed—and suddenly competitors became collaborators.


This organizational cooperation was matched with two key technological advantages that helped launch the Surge Line within a few days of the initial conceptual conversations.


The first bit of good fortune was that the ground had already been laid for a centralized transfer hub. Eighteen months earlier, Banner Health engaged with an access center solutions provider named Central Logic to improve our transfer process, including in our 17 hospitals in Arizona—an initiative that I led.


Through Banner’s Access Centers, our transfer agents have real-time visibility into bed capacity in all of our hospitals, the availability of specialists for consults and admissions, availability of medical devices and supplies, and numerous other key metrics needed to manage transfer traffic and trends. Importantly, referring physicians can reach Banner’s Access Centers by calling a single phone number for the entire health system, and the transfer and admission process is typically handled in one call. That was the type of process and visibility we wanted to replicate on a statewide level.


The other serendipitous circumstance was that Arizona’s health information exchange (HIE), Health Current, over the past 10 years had already integrated with 95% of the hospitals in the state. Their resource made creating a statewide level of visibility into health system resources for the Surge Line much faster.


Under normal circumstances, a stand up of a transfer center of this magnitude would take more than four months. ADHS and our technology partners were able to drastically accelerate the process. This was due in large part to Central Logic’s vendor-agnostic cloud-based information technology platform to manage the flow of data—as well as the many around-the-clock hours devoted by everyone involved in the initiative. Despite the state initiative being of a larger scale and shorter time frame than the Banner project, the Surge Line achieved a soft launch only two weeks after it was initiated.


The future of connected care

As of this writing, the Surge Line remains in the initial implementation phase with three transfer agents assisting referring physicians during the day in identifying the right level of care for their patients; two agents manage the line overnight. With cases increasing by the day, we are closely monitoring hospitals’ census as they near capacity—and in parallel, the state’s emergency triage level response.


Should there be a need to elevate triage levels and subsequent protocols, the Surge Line is prepared and ready to scale our transfer agents to meet the needs of our healthcare partners across the state. Surge Line callers also have access to physician consults if they do not intend to transfer a patient but still need clinical assistance from a specialist for critical or palliative care when on-call physicians are not available.


We are also continuing to enhance the usefulness and features of this statewide care-orchestration hub. For example, the Surge Line also can help us load-balance patients from critical care to lower-acuity settings such as skilled nursing facilities, and to coordinate transportation if resources are scarce.


During the current surge and any others that may occur in the future, Arizona’s hospitals and health systems are prepared with a care access resource they can rely on to help their patients with COVID-19 receive the care they need when it’s needed most.


As Arizona Gov. Doug Ducey recently noted: “This virus is not going away.”


None of this would have been possible without many stakeholders across healthcare and technology selflessly working together to improve outcomes and save lives.


In the future, for other major public health crises—whether they are due to another pandemic, a natural disaster or even a crisis such as a mass shooting—we will be prepared.