Research Summary

State-Level Hospital Transfer Coordination During COVID-Era Occupancy Stress Linked with Higher Transfer Rates, US Cohort Study Finds

Edited by:
Kate Young

Key Highlights:

  • Implementation of SMOCCs across 8 US states was associated with an immediate ~35% increase in IHT rates during pandemic surges.
  • After a lag period, transfers appeared to track increasing hospital occupancy stress, suggesting responsiveness to system strain.
  • Findings were consistent across rural and urban settings, transport modes, age groups, and patient acuity levels.
  • Long-term IHT rates showed a modest decrease following SMOCC establishment, highlighting dynamic temporal associations.

In U.S. hospitals experiencing pandemic-related strain, state-level coordination of patient transfers was associated with measurable changes in interhospital transfer activity, according to a cohort study published online in JAMA Network Open. The research investigated whether the implementation of state medical operations coordination centers (SMOCCs)—designed to centralize bed capacity data and manage patient placement—correlated with interhospital transfer (IHT) rates during periods of heightened hospital occupancy stress.

To assess the association between SMOCC activation and transfer patterns, investigators conducted a retrospective interrupted time series cohort study involving 441,709 adult IHTs in eight U.S. states (Alaska, Colorado, Idaho, Maryland, North Carolina, Oregon, Utah, and Virginia) from June 1, 2020, through December 30, 2022. SMOCC establishment dates were determined from surveys and health department inquiries, and transfer data were sourced from the National Emergency Medical Services Information System (NEMSIS). Hospital occupancy stress—an aggregated, weighted metric based on inpatient census and staffed beds—served as a measure of system strain across study weeks. Researchers applied negative binomial regression models to estimate immediate (step) and long-term (trend) changes in transfer rates relative to SMOCC initiation, controlling for seasonality and evaluating effect modification by occupancy stress.

Study Findings
Across the eight states, SMOCC start dates provided natural inflection points to compare IHT rates before and after implementation. The median patient age was 61.0 years (IQR, 44.0–73.0), and 51.6% of transfers involved male patients. Following SMOCC launch, investigators observed an immediate 35% increase in IHT rates (rate ratio [RR], 1.35; 95% CI, 1.05 – 1.74; P = .02), indicating a surge in coordinated transfers concurrent with system activation. Over the longer term, the overall transfer rate modestly decreased (RR, 0.94; 95% CI, 0.90 – 0.97; P < .001), though analysis revealed that by approximately 40 weeks post-implementation, each decile increase in occupancy stress was associated with higher transfer activity (RR, 1.23; 95% CI, 1.06 – 1.42; P = .007). Subgroup analyses showed similar patterns across urbanicity, transport mode, patient age, and acuity categories.

Clinical Implications
The study’s findings suggest that SMOCCs may facilitate timely movement of patients between hospitals during periods of extreme occupancy stress, potentially mitigating bottlenecks in access to higher-level care—a key concern during public health emergencies. Authors note, however, that utility outside of crisis conditions remains uncertain and warrants further investigation.

Expert Commentary:
“These findings provide a strong basis to reappraise the ongoing benefit of SMOCCs as a critical contingency and optimize their configuration and functions to maximize patient benefit,” the researchers concluded. “Further research should examine barriers to SMOCC adoption in other states and further elucidate the role of SMOCCs in improving patient flow in low-resource areas of the country.”

Reference:
Richert ME, Diao G, Mancera A, et al. Statewide transfer coordination and patient transfer rates among hospitals during occupancy stress. JAMA Netw Open. 2025;8(12):e2546002. doi:10.1001/jamanetworkopen.2025.46002.