A Spatial-Network Framework for Load Balancing and Patient Transfer Management During Emergencies.

Patient transfers provide a critical mechanism for enhancing care capacity and distributing patient load across hospitals and communities. Yet, during disasters and surge events, decisions about where to send patients are often made by Medical Operations Coordination Centers and similar centralized regional coordination bodies, with limited visibility into how transfers are unfolding across the broader hospital system. This study proposes a spatial-network framework, informed by a typology of patient transfers, that represents interhospital transfers as patient flows across a geographic network of hospitals. The framework provides tools to identify and interpret transfer patterns that coordination bodies need to enhance situational awareness and make timely, informed decisions at the local, regional, and state levels. Using inpatient discharge data from a Florida health agency, this study further demonstrates the framework's applicability during a disaster and shows how administrative health data can be transformed into spatial networks that support interhospital transfer coordination decision-making.