Table of Contents
Strategic Rationale
Inova recognized that access and flow are two sides of the same coin: effective entry into the system depends, in part, on the ability to move patients through it efficiently. Fragmented referral processes, siloed transfer protocols, and uneven bed utilization created delays that constrained both clinical capacity and patient experience. By unifying transfer operations, bed placement, and ambulatory referral routing, Inova aimed to:
Eliminate unnecessary transfer delays between points of care
Optimize existing capacity systemwide
Improve coordination between acute and ambulatory settings and reduce referral leakage
“You’re not building more, you’re not hiring more, but you’re creating virtual capacity.”
– VP, Operations, Clinical Enterprise
Overview
A suite of initiatives addresses a variety of throughput bottlenecks to ensure patients move smoothly through their healthcare journeys:
Transfer Center: Serves as a single systemwide hub for managing internal and external transfers, emergency activations (such as time-sensitive stroke or trauma cases), and specialty consults. Staffed with RNs and paramedics, it coordinates over 26,000 encounters annually, ensuring consistent intake and acceptance processes.
Centralized Bed Management (Capacity Management Team): Oversees real-time bed planning and placement across campuses (excluding L&D, Postpartum, and NICU), reducing placement times and improving utilization. Operates as part of the High Reliability Operations Center.
Unified Referral Backbone: Creates centralized referral work queues, standardizes clinical intake requirements, and supports direct scheduling from referral orders to streamline ambulatory follow-up. Schedulers proactively reach out to patients.
Time Frame
Most throughput initiatives were implemented between 2022 and 2024
Scale
Transfer Center: Handles over 26,000 transfers annually, covering systemwide movement across five hospitals
Capacity Management Team: Manages bed placement for all campuses, excluding maternity and NICU units
Referral Backbone: Supports 22 specialties for existing patients and 7 for new, coordinating scheduling for more than 427,000 online appointments annually, with 87,000 scheduled directly from referral orders
Goals and Competitive Advantage
By unifying transfers, bed management, and referrals, Inova expanded effective capacity and kept more patients within its network. The result is faster movement, stronger referral retention, and a seamless patient experience. Their goals were to:
Achieve a “system-level view” of capacity across all hospitals and ambulatory sites that enables data-driven decision-making to maximize efficiency and give a strategic edge in forecasting, surge planning, and resource allocation
Reduce throughput bottlenecks that contribute to ED crowding and inpatient boarding
Build standardized referral and placement processes that optimize utilization to reduce leakage and strengthen referral capture
Strengthen operational alignment across acute and ambulatory settings
Results
42% increase in accepted external transfers
40-minute reduction in bed request-to-placement time
39 additional ER patients seen daily without additional resources
25% year-over-year reduction in inpatient boarder hours (2022–2024)
Streamlined referral-to-scheduling workflows for 29 specialties
Level of Investment
Inova’s approach emphasizes redeploying and centralizing existing resources under the High Reliability Operations Center, rather than adding net new FTEs. This space was created with a hospital-grade backup power system, which was the most costly one-time investment. Otherwise, this was relatively low lift as most team members already existed elsewhere in the system and were centralized.
Lessons Learned
Centralize to stabilize. Placing the Transfer Center and Capacity Management teams together within the High Reliability Operations Center enabled real-time coordination, cutting placement lag times and avoiding the “handoff fog” that plagued decentralized processes. Consolidating previously fragmented workflows under a single command structure enabled shared oversight so that technology or staffing could meaningfully improve patient flow.
Consistency starts with a shared definition. The referral backbone required acute and ambulatory teams to agree on what constitutes a complete referral and how follow-ups are scheduled. Establishing uniform criteria reduced rework and made downstream scheduling predictable.
A mindset shift pays off. Inova needed to shift the narrative that someone who wasn’t sitting in the four-walls of a campus couldn’t provide the same level of service as some who was.
