Hospital capacity management teams are making space for miracles
Behind the scenes, it takes smart capacity management systems to serve patients who need nothing less than the most advanced health care available anywhere.
A phone call comes into the Penn Medicine Transfer Center. The nurse who answers learns that another hospital in the region has a patient in cardiogenic shock—his brain and vital organs aren’t receiving enough oxygen, his heart not pumping enough blood. To survive, he needs to go on extracorporeal membrane oxygenation (ECMO), a highly specialized life support system that takes over heart function and is usually only available at major medical centers.
Immediately, Transfer Center managers activate a Penn cardiologist and cardiovascular surgeon to review the patient’s case and develop a rapid cycle plan for rescue. To carry out that plan, they locate an available bed at Penn Presbyterian Medical Center. They connect the regional hospital providers on a phone call with the PennSTAR flight team, which is preparing a helicopter to transport the patient, and with the care team at the hospital who will be ready as soon as the helicopter touches down. Environmental services staff are mobilized to prepare the patient’s room.
Cases like this one are considered Level 0, meaning the goal is to get the transfer patient into a Penn Medicine facility within two hours.
But finding and creating capacity to admit patients to the hospital is something that happens all the time—not just in life-threatening emergencies. Behind the scenes of a busy health system like Penn Medicine, it takes a carefully orchestrated interplay of clinical decision making and timely resource management to get patients into hospitals when they need to be there, getting the care they need.
Penn Medicine teams make miracles happen for patients in crisis every day: life-saving trauma response, emergency stroke rescue, urgent neurosurgery. The health system is also home to other types of highly specialized care that few other centers can offer for rare and complex health problems—including one of the largest organ transplant centers in the nation. At the same time, countless patients continue to rely on Penn Medicine for more common surgeries and medical treatments that require hospital-level care. Across this spectrum, demand consistently exceeds the available hospital beds.
Health systems nationwide are facing increased capacity pressure. Though Penn Medicine isn’t the first to address this common pain point, the health system is seeing early successes as it scales up and centralizes once-disparate departmental and hospital-based capacity efforts with the goal of creating a system-wide solution. With seven acute-care hospitals spanning a geographic range of hundreds of miles, from central New Jersey to central Pennsylvania, it’s a substantial challenge.
“Our system sees some of the most complex cases in the world,” said Robin Wood, PhD, MSN, vice president for system capacity and patient flow at the University of Pennsylvania Health System. “We want to have the capacity to care for patients that need specific care, whether it’s transplant care at the Hospital of the University of Pennsylvania (HUP) or trauma care at Lancaster General Hospital. To have the capacity for the sickest of the sick, we need to make sure our supply is matching our demand.”
Taking the call
Given the health system’s renown and highly specialized expertise, it’s perhaps unsurprising that the Penn Medicine Transfer Center gets calls day and night from around the globe, with the highest volume of requests for HUP. Transfers to Penn’s emergency rescue programs, including heart, lung and neuro rescue (at Penn Presbyterian and HUP), and the health system’s specialized clinical programs in fields including bloodless medicine (at Pennsylvania Hospital and Chester County Hospital) and orthoplastic limb salvage for saving a severely injured or diseased limb at risk of amputation, all flow through the Transfer Center. Its managers once facilitated the transfer of a patient from Antarctica—by way of an outpost hospital in South America—for emergency neurosurgery.
The Transfer Center fields dozens of requests each day. Emergent cases, such as certain cancer diagnoses, heart failure, and post-transplant patients, have a call-to-bed timeline of eight hours. Urgent cases and elective requests from patients and families are usually processed within 24 hours. As many as 20 people from the Transfer Center, the accepting department, and PennSTAR can be on these calls.
All of this planning happens without the team seeing each other—or the patient—face to face, said Amanda Whartenby, clinical director of the Capacity Management Center. “Someone else has to be your eyes, and you have to ask the right questions to put the picture together,” she said. “Critical thinking is needed in this job.”
In the fiscal year that ended June 30, 2025, the Transfer Center placed just over 9,200 patients through both external requests from other systems and internally across Penn Medicine. Among these, the most-requested services included cardiovascular medicine (1,617 transfers), pulmonary (1,211), and neurosurgery services (998). HUP received the majority of these transfers—53 percent.
“We’re constantly prioritizing and reprioritizing to keep the flow moving,” said Joshua Davis, director of operations of the Capacity Management Center. “We’re making time-sensitive decisions because we have real-time, competing priorities.”
The constant undertow of demand
At the same time that HUP and Penn Presbyterian are in high demand for their advanced, highly specialized care, they are also both hospitals that draw patients for other urgent health care needs—both local residents who rely on them for unexplained pains and broken limbs, and patients who have sudden concerning symptoms during cancer treatment or after a transplant. And on top of these year-round needs, the hospitals’ emergency departments become even more crowded during viral illness outbreaks. The same holds true for Lancaster General Hospital in its community 80 miles to the west.
That’s why inpatient capacity management—that is, balancing patient demands with the availability of the hospitals’ finite number of beds and staff—is particularly crucial. And at Penn Medicine, it’s increasingly something considered from a system-level view.
“Let’s place you in a Penn Medicine facility that can best meet your needs,” said Wood, who worked as an emergency nurse for 18 years before moving into her current role overseeing the Capacity Management Center. “That means thinking a little bit differently than how we used to think, which was, ‘If they arrive in your building, they’re yours.’”
A handful of other health systems nationally have begun to manage their operations to place patients in different hospitals in this way. For Penn Medicine, it is a paradigm shift still in early stages.
Since July 2025, the Penn Medicine Capacity Management Center has functioned as a more centralized resource than ever before. It encompasses the Transfer Center for the health system, and the PennSTAR flight program and PennCOMM flight dispatch center, and most recently added unified bed management for all three of Penn Medicine’s hospitals in Philadelphia.
As they work as part of this centralized team, Transfer Center managers weigh a hospital’s capacity as a factor when placing patients. They have the full breadth of Penn Medicine’s expert programs across the region at their disposal. Because both Penn Presbyterian Medical Center and Lancaster General Hospital can take complex trauma cases, for instance, sometimes a patient is sent to Lancaster if there are already patients waiting for inpatient beds at Presbyterian. Patients are also moved within the Penn Medicine system. Some 42 percent of transfers are intra-hospital transfers from one Penn facility to another.
With the integration of all three of Penn’s Philadelphia-based hospital bed management teams this July, the same principle holds true for any patient in need of a hospital bed in the city: The team will seek out the best place to care for that patient with capacity to care for them right away.
It’s a first step toward the effort to build a system-wide bed management center. Wood also continues to work to strengthen the Transfer Center’s relationships with Penn Medicine hospitals across other parts of the region.
“We offer different services and care for patients with different needs at different entities, but it is all Penn Medicine care,” she said. “That’s what we want to deliver.”
Walking through a different door
The more system-based model of inpatient admissions has seen early successes with Penn Medicine’s two inpatient psychiatric units in Philadelphia.
Penn Medicine centralized its inpatient and crisis psychiatric care at two locations in the city in 2023: Pennsylvania Hospital in Center City, and HUP–Cedar Avenue in Southwest Philadelphia. Because patients in hospital psychiatric units spend time interacting with each other, nurses in each unit had to ensure new referrals would fit into its social environment. This created a referral backlog, causing crowding problems in emergency departments and psychiatric crisis response centers.
Yet only half of the inpatient psychiatric beds at HUP–Cedar Avenue were filled at any given time. “That was no fault of anybody at Cedar or anywhere else,” said Katharine Dalke, MD, the Benjamin Rush Associate Professor in Clinical Psychiatry and vice chair for clinical operations in Psychiatry. “We just hadn’t built a system that would help us get patients there. It wasn’t working.”
The Psychiatry department partnered with the Transfer Center to develop a more streamlined system: Now the Transfer Center assigns referrals to available beds under nurse review. This saves nurses’ time, and helps fill beds at both hospitals.
Since the collaboration began in January 2024, referred patients are getting into the hospital about two hours faster, Dalke said. And occupancy rates at HUP–Cedar Avenue inpatient psychiatry have topped 90 percent, up from 30 to 50 percent previously. “We’re thinking outside of our immediate practice and working toward the same goal of getting every single patient where they need to go in a safe way,” she said. “These patients are all our responsibility.”
Creating capacity
For Wood and other leaders, these changes to inpatient psychiatry admissions served as a strong proof of concept for the vision of admitting patients to the right hospitals at the right time, across the system. But the capacity management challenge becomes much more complex when a specialty unit is, rather than half empty, consistently packed.
“Our coordination and communication has to be better than ever, particularly when you’re in the business of managing the most complex patients in the region,” said William Schweickert, MD, a pulmonary and critical care physician and physician executive for patient access and throughput at HUP.
If HUP has an intensive care unit jammed with patients with flu complications, for instance, care for acute cancer patients could be disrupted. To prevent this, for example, a larger share of patients with respiratory illness could be admitted to other hospitals. “We have to consider which services only HUP can provide, and which can be met within the system fast and effectively.”
As part of keeping HUP available for the patients who need its specialized services, inpatient capacity management also focuses on “length of stay” metrics, or the time from a patient’s admission to their discharge.
“We are not rushing people through the hospital,” Schweickert said. “We want to meet their needs efficiently and effectively and get them home. The length of stay effort is a virtuous effort; the best thing we can do for all our patients is to help them progress toward returning home, so more patients can get access to care. There’s always a queue of patients waiting to come in.”
At Penn Medicine, length of stay improvements are measured by a decrease in “excess days,” that is, the extra days a patient remains hospitalized beyond what is optimal for their condition. In the fiscal year when this work began, from July 2023 through June 2024, Penn Medicine’s excess patient days decreased by approximately 60 percent—a major efficiency win that allowed the health system to care for 1,700 additional patients. From July 2024 through June 2025, there was a further decrease—leading to capacity to care for a total of 3,300 more patients over the two years.
Schweickert and Wood, along with other members of HUP’s access leadership team, say these wins are owed not to any single process improvement, but to the accumulation of many intentionally coordinated steps. They included the efforts of every person involved in a patient’s hospital stay, from front-line clinicians to administrators to environmental services staff.
The team developed a shared language and framework to discuss the inflows that brought patients to HUP and the outflows that could move them to the next best place for them to be—ideally home. And they developed comprehensive data dashboards to identify issues and communicate with staff in the hospital units about why this work matters—that the goal was not merely to discharge more patients by noon, for example, but to make space to admit sick patients waiting in the emergency department.
Units stood up daily interdisciplinary rounds to ensure that clinicians on the unit talk with one another, and with their patients, about each patient’s plan for care and progression toward leaving the hospital.
When the clinical teams notice cases that caused concern, they elevate them to a select group of clinicians from multiple units at HUP, mostly nurse leaders, who now take part in a daily call for capacity management and optimization. On these calls, participants succinctly summarize their patient population and the complex factors affecting inflows and outflows. While sharing ideas and problem-solving together, they gain support from hospital leaders to build more systemic solutions. Some of these may be internal hospital process changes, such as implementing a tiered surge model, or plans of action that shift temporary responses during periods of heightened capacity strain. Such a plan might entail placing some patients in a different location at times—such as medical patients on a surgical floor—while continuing to receive the same care from the same teams. Other longer-term solutions involve building or strengthening relationships with other hospitals or ambulatory programs to provide smoother pathways for patients to safely leave HUP.
One system of care
After dramatic improvements in hospital capacity during the first two fiscal years of the centralized effort, Wood and others anticipate further progress may be slower after the earliest, easiest wins.
“Capacity management takes time to see results,” Wood said. “You just have to keep chipping away at it. There's no magic bullet. It's different initiatives coming together.”
Future initiatives will include strengthening partnerships that help patients transition into other Penn Medicine programs that wrap support around patients outside of hospital settings. Many of these advanced outpatient, virtual, and home-based care programs already help patients either avoid a hospital stay or go home sooner.
Collectively, these efforts sit at the center of Penn Medicine’s drive to meet its missions and do right by all of its patients.
Making sure the system has access to admit patients with the most advanced and critical care needs is crucial, Schweickert said. “Complex care, such as thrombosis and surgical rescue, cellular therapy, transplantation, and cardiovascular and endovascular repair available at HUP provides us the strong operational foundation to deliver advanced community care in our region.”
Complex care at HUP and throughout Penn Medicine is not just essential for the patients receiving that care: It makes it possible for the health system to invest in innovation, and to fulfill commitments to community care for services that are typically reimbursed less by insurers, such as free and low-cost cancer screenings, or diabetes care and dialysis treatment.
In these ways, making space in the hospital is making all kinds of medicine possible.
“We’re trying to do the best thing for the patient,” Wood said, “to get them where they need to be. That's our guiding light.”