The Procedure-Only Transfer Pathway - An Alternative to Standard Interhospital Transfer to Address Time-Sensitive Procedural Needs.

Abstract

Minimally invasive procedures - performed by health care professionals in gastroenterology, interventional radiology, and electrophysiology - are now standard of care for management of many inpatient conditions. However, the physical infrastructure and technical expertise required to perform these interventions are increasingly concentrated within urban and academic centers. Patients with advanced endoscopic or electrophysiologic needs who are hospitalized at rural or community hospitals are thus dependent upon expedient interhospital transfer for access to needed procedures. As hospital capacity has become tighter, those patients awaiting transfer experience prolonged wait times, leading to care delays and even suboptimal outcomes. In response, Oregon Health and Science University created the procedure-only pathway, through which patients are transferred from the referring hospital to the tertiary care center solely for procedural intervention, after which they are immediately transported back to the referring institution. This alternative to traditional interhospital transfer was designed to be patient-centered, facilitate access to scarce resources, and preserve beds at the academic center for those with ongoing tertiary care needs. Extensive multidisciplinary collaboration was required to create safe, facile workflows for this process. Recurrent feedback from stakeholders, including hospitalists, proceduralists, anesthesia, billing, and the transfer center team was imperative to refine the pathway. While the administrative hurdles were high, they were not insurmountable, and the program yielded significant benefits for patients and hospitals alike. The innovation led to markedly decreased wait times for inpatient procedures. Over a 3-year period, patients arriving via the procedure-only pathway obtained indicated procedures 1.52 days after the initial transfer call, compared with 4.99 days for those transferred by the standard route. No significant increase in complications was observed among the procedure-only cohort. The annual volume of procedure-only cases continues to grow as the billing, legal, and transportation infrastructure has matured. While only eight such cases were performed in 2021, 93 were completed in 2025. Finally, as procedure-only transfers ramped up, the authors observed a proportional decrease in the number of patients waitlisted to their institution but ultimately transferred to another hospital system owing to prolonged delays for beds. The procedure-only pathway keeps high-value procedures within the system. Because of the success of the procedure-only pilot, Oregon Health and Science University is creating contracts with additional referring hospitals and expanding its inclusion criteria to additional procedural types - including interventional pulmonology and diagnostic radiology.