CASE STUDY

Arizona Surge Line: A unique collaborative response to the COVID-19 pandemic and beyond

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Case Studies

As we’ve learned from other states, it’s critical to protect our healthcare system by ensuring that no region of the state is overwhelmed by COVID-19 patients while another region’s hospitals remain empty and ready to serve.

Cara Christ, MD, MS

Director, Arizona Department of Health Services

The Challenge
Load balancing a surge of patients across an entire state
 
The nightmare scenario goes something like this: A pandemic inundates several hospitals beyond their ability to provide timely, effective care for infected patients. As a result, patient outcomes suffer broadly, and some individuals die needlessly. Meanwhile, in the same state or region, physicians, beds, and equipment at other hospitals stand idle, ready to serve patients.
 
Facing the COVID-19 pandemic, state and healthcare leaders in Arizona saw the potential for this kind of scenario — and they knew they needed to join together in taking swift preventive action. They had a vision for a regional approach, in which hospitals with strained capacities or a lack of sufficient capabilities could efficiently transfer patients to other hospitals with available beds and advanced care, regardless of health system affiliation.
 
The Response
From inception to fully operational in less than 2 weeks 
 
Building a well-run transfer center, regardless of its size or scope, starts with knowledgeable and talented people. The Arizona Surge Line would be staffed with clinicians who could quickly evaluate the needs of presumed or confirmed COVID-19 patients and then arrange transfers to participating hospitals. In addition, the Surge Line would enlist critical care and palliative care providers offering real-time clinical consultations to support clinicians managing COVID-19 and end-of-life care where resources are scarce.
 
The choice of a technological framework for the Surge Line would prove critically important, too.
 
Fortunately, Larsen already possessed a wealth of experience running the transfer services for Banner Health, Arizona’s largest health system comprising 20 hospitals. Powering Banner’s transfer center: Central Logic.
 
“When the state contacted me to stand up the Surge Line, I said ‘yes’ — as long as we can use Central Logic, because I know it will work and we can quickly make it happen on a statewide level,” he says.
 
Fast indeed. On April 21, less than two weeks after the project’s inception, the Arizona Surge Line was operational and taking its first calls. 
 
Larsen believes that teamwork has been crucial to the Surge Line’s launch and its early success. “These health systems are competitors. To be able to come together, putting aside their differences, has been inspiring. We’ve already had conversations that after we get through the current crisis, we cannot lose this momentum. Going forward, we should be getting together for patient transfer discussions and working collaboratively.”
 
Dr. Christ echoes Larsen’s sentiments: “We greatly appreciate the leadership of Arizona healthcare systems in coming together to support this launch.”
 
And, while the Surge Line responds to an immediate need, it’s designed to be applied to any threat that could lead to a healthcare surge, whether it’s another wave of COVID-19, a new pandemic, a natural disaster, or any catastrophic event that generates a sudden spike of patients. “We’ve built our Surge Line for the long haul,” states Larsen.
 
Technological support
Scaling up a proven solution for a public health system
 
From a technological perspective, the state of Arizona and the Surge Line had a solid head start, thanks to the experiences of Banner Health with the Central Logic access center solution.  
 
“Our solution is purpose-built for this kind of scenario,” explains Central Logic CEO, Angie Franks. “We empower individual health systems to achieve systemness — operating as one organization to orchestrate the movement of patients to the right location for the care they need, in a very timely manner. For the COVID-19 pandemic, we’ve scaled up our solution to help a public health system operate as one and ensure that patients get high-quality care in an optimal timeframe.” 
 
The Surge Line leverages several components of Central Logic’s solution to achieve patient load balancing across the state. It gives Surge Line agents real-time visibility of the state’s available ICU beds, physicians, ventilators, and personal protective equipment (PPE). It also enables emergent and non-emergent transport coordination, along with real-time tracking of patients. 
 
One especially valuable aspect of the Central Logic solution is that it uses the data feed from the state’s health information exchange, HealthCurrent. In addition, Central Logic uses a vendor-agnostic, Microsoft Azure-based platform to integrate data from any EHR and other third-party systems. As a result, decision-makers have access to a robust set of key metrics in real time, such as the movement of patients to and from hospitals, as well as testing capacity and processing times, infection rates, patient demographics, and comorbidities. These and other analytics help fuel on-the-fly adjustments and long-term strategic planning. 
 
Larsen stresses that the Surge Line does not supplant the transfer and access centers operated by participating health systems. “It sits on top of, and is the front door to, all of the individual transfer centers for COVID-19 referrals,” he says. 
 
For this and many other reasons, the Surge Line has enjoyed strong acceptance by health systems statewide, supporting the ultimate aim to protect and improve the health of Arizonans. The historic initiative also has showcased Arizona as a national role model for how to effectively manage a surge of patients caused by a pandemic or other crisis — attracting the attention of healthcare leaders in other states.  
 
“We’re prepared to build on our experience in Arizona to rapidly stand up centralized systems for load balancing COVID-19 patient care across other areas of the country,” says Central Logic CEO Angie Franks. “With the right people at the helm and proven technology at their fingertips, state or regional transfer centers can increase the effectiveness of their response to the current pandemic while ensuring readiness for future healthcare emergencies.” 
 
Executive Summary
 
Determined to prevent hospitals from being overwhelmed with COVID-19 patients, the state of Arizona launched an unprecedented initiative to stand up a statewide transfer center. To be successful, such a massive undertaking would require talented, experienced leaders from the public and private healthcare sectors. It also would demand the careful selection of various supporting technologies. 
 
A number of formidable issues awaited the Arizona Surge Line team, including: 

  •     Satisfying the concerns of health systems that are normally competitors
  •     Developing and implementing the Surge Line in a matter of weeks
  •     Enabling complex patient transfers across a vast geographic area
  •     Meeting the needs of a diverse array of healthcare organizations
  •     Capturing and using data from disparate EHR and other third-party systems

Members of the team not only overcame every challenge and roadblock, but they got the Arizona Surge Line up and running in less than two weeks.  
 
One of the keys to this expedited implementation and the Surge Line’s success was the choice of Central Logic’s access center solution for managing patient transfers. In particular, the team leveraged the prior experience of Banner Health with Central Logic, essentially scaling up the solution to meet the needs of a “mega” public health system. 
 
Today the Surge Line is delivering on Arizona’s vision to load balance COVID-19 patients across the state. Moreover, public and private healthcare leaders enjoy peace of mind knowing the system can be reinstated rapidly should the state find itself in a similar predicament down the road. 
 
This was the impetus for the Arizona Surge Line, a groundbreaking collaboration involving the Arizona Department of Health Services (ADHS) in partnership with all of the state’s major health systems and hospitals. 
 
“As we’ve learned from other states, it’s critical to protect our healthcare system by ensuring that no region of the state is overwhelmed by COVID-19 patients while another region’s hospitals remain empty and ready to serve,” says ADHS Director Dr. Cara Christ. “Establishment of the Arizona Surge Line is a key initiative to protect Arizona patients and hospitals by making sure Arizonans are transferred to the right level of care at the right time for the best outcome.” 
 
To get the Surge Line started right — and operational as quickly as possible — ADHS tapped into the state’s top healthcare thought leaders. One of those experts, Charles Larsen, MSN-L, MBA, RN, NEBC, serves as Senior Director of Transfer Services at Phoenix-based Banner Health.  
 
Recognizing Larsen’s extensive transfer center experience, ADHS asked him to lead development and implementation of the Surge Line. Banner not only gave its blessing to the request, but temporarily “loaned” Larsen to ADHS full time so he could focus 100% on an unprecedented initiative.  
 
In early April 2020, Larsen and his team hit the ground running, fully cognizant of the highly infectious nature of COVID-19 and its history of overwhelming health systems in a matter of days. But they also were adamant that a fast-track timeline could not compromise the Surge Line’s mission to effectively load balance patients across an entire state, even under the most demanding circumstances.

Developed and implemented
the Arizona Surge Line
in less than 2 weeks.

HIGHLIGHTS

Challenge

  • Create a centralized system for load balancing COVID-19 patients across an entire state, to prevent overwhelming some hospitals while others have available capacity
  • Gain approval and participation from normally competing health systems
  • Quickly get the system up and running in the face of a surging pandemic

Solution

  • The Arizona Surge Line, giving hospitals anywhere in the state one phone number to request the efficient transfer of COVID-19 patients to the appropriate level of care
  • Includes transport coordination and real-time patient tracking
  • Leveraged the experience of Banner Health with Central Logic to scale up a statewide transfer center in less than two weeks
  • Designed to handle future patient surges from a pandemic or other event

When the state contacted me to stand up the Surge Line, I said ‘yes’ as long as we can use Central Logic, because I know it will work and we can quickly make it happen on a statewide level.

Charley Larsen, RN, MSN, MBA, CNML, NE-BC

Senior Director, Transfer Center Services, Banner Health

With the right people at the helm and proven technology at their fingertips, state or regional transfer centers can increase the effectiveness of their response to the current pandemic while ensuring readiness for future healthcare emergencies.

Angie Franks

CEO, Central Logic

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