Intake Hospitalist: A New Role to Maximize the Safety and Efficiency of Interhospital Transfers

SummaryThe interhospital transfer process is complex and susceptible to logistic errors, inefficiencies, and patient harm. Historically, hospitalists at Oregon Health & Science University (OHSU) were responsible for managing incoming Medicine transfer requests in addition to concurrent clinical and teaching duties. Transfer patients sometimes arrived unprepared for planned interventions, lacking necessary records, or clinically unstable. Others were transferred without a clear need for a higher level of care. In response, OHSU created the Intake Hospitalist role — a dedicated and specially trained hospitalist without other clinical and educational duties, who manages all direct admissions, intrahospital transfers of service, and interhospital transfer requests to the Medicine service. The goal of the Intake Hospitalist program is to improve the quality and safety of the transfer process and accept the "right patient, at the right time, to the right place." The role was implemented in January 2021 and has led to appreciable improvements in patient safety, standardization, bed utilization, and physician experience. Notably, the authors found the cost of this program has been offset by the indirect financial savings created through backfill of inpatient beds with higher-complexity patients. The Intake Hospitalist has proven so successful that OHSU developed similar roles for the ICUs and Pediatrics during high-demand situations. The authors believe this model could be successful at other large academic centers.