Structures and Resources to Support Patient Transfers and Patient Load Balancing

December 9, 2020

With COVID-19 cases and hospitalizations on the rise, many GNYHA members have begun to activate their surge plans. These plans:

  • Use a “dimmer switch” approach to maintain routine services for as long as possible while also meeting the demands of COVID-19
  • Add surge capacity in a stepwise fashion as dictated by growing demand, using a combination of repurposed and redeployed resources and surge resources
  • Rely on patient load balancing as a key strategy. For independent hospitals, this involves capacity-driven transfers, and for health systems, the movement of patients from hospitals experiencing higher patient volumes to those with lower volumes.

GNYHA provides extensive resources and services to help members with their surge planning and response. These include:

  • Collection and distribution of data critical to monitoring and surveillance
  • Coordination among members and response agency partners
  • Policy and regulatory advocacy
  • Assistance in accessing critical resources
  • Facilitation of regional load-balancing strategies, including assistance with patient transfers

This document further details these resources and structures.

New York State Structures in Support of Patient Surge

The New York State Department of Health (DOH) has issued numerous emergency regulations related to hospital and health system surge capabilities, including the Surge and Flex Health Coordination System, which was described in regulations issued in early August. Hospitals also are required to report information daily through the DOH Health Electronic Response Data System (HERDS). During the spring 2020 patient surge, DOH activated the Hospital Capacity Coordination Center (HCCC), which assisted with resource needs and patient transfers. GNYHA understands that DOH will soon activate the HCCC to support the current patient surge. GNYHA will closely coordinate its efforts and activities with those of the HCCC.

GNYHA’s Role in the Downstate Region

GNYHA already helps members with their patient surge needs. With the tools below, we are ready to assist members with patient transfers and will do so in coordination with local response partners and the DOH HCCC. 

Proactive Outreach to Members

We will continue to proactively contact members that, based on available data, appear to be experiencing high levels of surge or capacity constraints.

For assistance with patient transfers or surge-related issues, please contact Lorraine Ryan or Jenna Mandel-Ricci.

Regulatory Flexibility

On December 3, New York State Governor Andrew Cuomo issued an Executive Order to enable hospitals to rapidly transfer or receive patients and use inter- or intra-system patient load balancing as required by the DOH Commissioner, provided facilities take all reasonable measures to protect the health and safety of such patients, including by following safe transfer practices.

Sit Stat 2.0: Available Data and Key Contact Information

COVID-19 Surge Data

Currently, 115 New York State member facilities participate in GNYHA’s Sit Stat 2.0 situational awareness platform. On November 20, these members began submitting daily responses to a Hospital Surge Indicator and other questions about surge actions, including the use of surge beds, staff redeployment, and patient transfers due to capacity. This information enables the hospital community, GNYHA, and response partners to understand how hospitals and health systems are managing patient volumes.

GNYHA combines hospital responses with key data from DOH’s daily HERDS survey (on hospital COVID-19 patients and bed availability) in a single view titled:

  • New York State COVID-19 Surge (for all facilities outside New York City)
  • New York City COVID-19 Surge (for all facilities within New York City)

GNYHA encourages members to routinely review this information as a part of ongoing surveillance and monitoring activities.

Key Contact Information for Transfers

Members can access contact information for all member health system transfer centers and key transfer contacts for independent hospitals within Sit Stat 2.0’s New York State Transfer Information view.

Additional Surveillance Resources for NYC Members

Each morning GNYHA posts to its website an Emergency Department Syndromic Surveillance Report created by the NYC Department of Health and Mental Hygiene, as well as a Daily Morgue Census Report produced by the NYC Office of the Chief Medical Examiner. GNYHA staff send an email each morning alerting members to the availability of these reports. To be added to the distribution list please contact Rosanne Casey.

Independent Hospital Resources

Independent hospitals are strongly encouraged to have detailed discussions with routine transfer partners regarding how capacity transfers will occur. These conversations should include what types of patients are best suited for transfer (i.e., those in the Emergency Department awaiting admittance), communication around transfers, family notification procedures, and likely capacity at receiving facilities.

Coordination with EMS

Informing Ambulance Destination Algorithms

GNYHA is working closely with the New York City Fire Department (FDNY) Bureau of Emergency Medical Services (EMS) to incorporate the Hospital Surge Indicator into its existing ambulance destination algorithms. The goal of this effort is to slow the volume of ambulances to hospitals reporting higher levels of surge, a concept sometimes referred to as “precanting.” GNYHA will provide detailed information to New York City’s 911-participating facilities as these plans are finalized.

Supporting Patient Transfer Activity

When members need assistance with transfers, GNYHA staff will coordinate with NYC Emergency Management’s Transportation Branch to arrange for transport resources.

Use of Existing Structures

In many counties and regions, mutual aid arrangements and processes already exist, including the Hudson Valley Mutual Aid Coordinating Entity (MACE) Team and the Western New York Mutual Aid Coordinating Group. Additional structures overseen by counties and the DOH Healthcare Emergency Preparedness Councils are routinely convening hospitals and health systems to discuss patient volumes and surge strategies.

GNYHA Meetings and Participation

GNYHA convenes downstate health system transfer center leaders on a weekly basis. GNYHA also uses its monthly Emergency Preparedness Coordinating Council meeting to share critical information and updates. Additionally, GNYHA staff regularly participate in coordination meetings with New York City response partners.

Safe Discharges

GNYHA continues to work with DOH to move forward the Infectious Disease Specialty Care Center Model. Under this model, DOH would designate certain high-performing nursing facilities to receive transfers from other nursing facilities and recovered COVID-19 patients who have not yet tested negative from hospitals.  GNYHA also continues to work with DOH and other partners on planning for the use of government-supported alternate care sites such as the Javits New York Medical Station.Additional information about COVID-19-related resources and GNYHA staff contacts can be found in this comprehensive memo.