The Arizona Surge Line

How competitors became collaborators for the good of Arizona during the COVID-19 pandemic.

The setting is February 2020. COVID-19 is still new and is raging through states such as Washington, New York, and New Jersey. Hospitals are overwhelmed and the news is flooded with heart-wrenching stories of patients dying in hallways alone, unserved. Witnessing this, the state of Arizona Department of Health went to work. Emergency Preparedness Medical Director, Dr. Lisa Villarroel, met with state officials in those states hit hardest. Lessons were learned; warnings were heeded. “We had hospitals completely overwhelmed while hospitals across the street, across the city, across the state had beds and staff ready to serve. We just didn’t know who had beds nor how to get patients to those places to receive care."

Now, as of this writing in January 2022, COVID cases and deaths are on an exponential growth curve in the state for a third time.

However, Arizona is and has been better prepared than most other states that have also faced this relentless cycle of COVID variants. That’s because in the beginning, Arizona’s Department of Health Services (ADHS) created a first-of-its-kind regional access center that any physician statewide can call to transfer a patient with COVID-19 from their hospital to one of the dozen or so health systems admitting patients in need of critical care.

The regional access center, dubbed the Arizona Surge Line, launched on April 21, 2020. As of this writing, the service has managed thousands of COVID transfer cases, with the capacity to handle more than 150 per day if needed.

How the state got to this point is a story of foresight, fortunate circumstances, and hard work.

Most of all, it is an inspiring example of how healthcare industry competitors can put their market share and financial concerns aside to collaborate—even though all were devastated by a downturn in patient volume and intermittent limiting of elective surgeries. Together, we aligned resources and found solutions to ensure every patient with COVID-19 receives the right level of care without delay, while also protecting the health and safety of frontline clinicians by ensuring adequate access to PPE.

Learning from Other States

As previously mentioned, while COVID-19 spread from the U.S. coasts, officials from the ADHS recognized that a statewide patient load-balancing system would be required, whether those hospitals were across town from each other or in distant parts of the state. They had witnessed what had happened in New York City where some hospitals were overwhelmed with patients, while other healthcare facilities went largely unused.

To drive the statewide service, ADHS leaders knew that they needed faultless processes and operations that would allow for accurate and real-time data providing visibility into bed capacity, clinician, and ventilator availability across the state’s 100-plus hospitals. This was a significant undertaking given that a statewide hub like this had never been attempted before anywhere in the country.

As Senior Director of Banner Health Transfer Services, the largest health system in the state, I had been in contact with ADHS officials about the anticipated surge. After we discussed what resources would be needed statewide, Banner Health generously allowed me to temporarily step aside from my health system duties to lend my time and expertise to the initiative as an in-kind donation.

Rapid Ramp-Up

Within a few days of the first conversations about the Surge Line initiative, leaders from every major health system and hospital in the state were on numerous conference calls together to learn more about the ADHS plan and why we needed to combine resources across the state to benefit patients.

Fortunately, everyone agreed—and suddenly competitors became collaborators.

This organizational cooperation was matched with some key operational advantages that helped launch the Surge Line within a few days of the initial conceptual conversations.

The first bit of good fortune was that the ground had already been laid for a centralized transfer hub. Eighteen months earlier, Banner Health engaged in (and was wildly successful through) an extensive process improvement project aimed to improve our transfer process, including in our 17 hospitals in Arizona—an initiative that I led.

Through Banner’s access centers, our transfer agents had visibility into quality analysis vetted data that showed bed capacity in all of our hospitals, the availability of specialists for consults and admissions, availability of medical devices and supplies, and numerous other key metrics needed to manage transfer traffic and trends. Importantly, referring physicians can reach Banner’s access centers by calling a single phone number for the entire health system and the transfer and admission process is typically handled in one call. That was the type of process and operations we wanted to replicate on a statewide level.

Under normal circumstances, a stand up of a transfer center of this magnitude would take more than six months. ADHS and our other partners were able to drastically accelerate the process. This was due in large part to the many around-the-clock hours devoted by everyone involved in the initiative. Despite the state initiative being of a larger scale and shorter time frame than the Banner project, the Surge Line achieved a soft launch only two weeks after it was initiated.

The Future of Connected Care

As of this writing, the Surge Line has matured to also assist with post-acute placement, transportation, and nurse staffing. The call center is staffed with just two agents 24/7 and they are able to manage all surges and individual unique circumstances that are thrown their way. With cases wildly variable by the day, we are closely monitoring hospitals’ census as they again near capacity—and in parallel, the state’s emergency triage level response. Should there be a need to elevate triage levels and subsequent protocols, the Surge Line is prepared and ready to scale our transfer agents to meet the needs of our healthcare partners across the state. Surge Line callers also have access to physician consults if they do not intend to transfer a patient but still need clinical assistance from a specialist for critical or palliative care when on-call physicians are not available.

During the current surge and any others that may occur in the future, Arizona’s hospitals and health systems are prepared with a care access resource they can rely on to help their patients with COVID-19 receive the care they need when it’s needed most.

None of this would have been possible without many stakeholders across healthcare selflessly working together to improve outcomes and save lives. I often cite this as the most inspirational piece of this entire project. I partnered with hospital executives from around the state to make this happen. We all came together as competitors and continue to exist 2 years later as collaborators.

In the future, for other major public health crises—whether they are due to another pandemic, a natural disaster or even a crisis such as a mass shooting—we will be prepared.

Further Reference Regarding the Arizona Surge Line:

EXECUTIVE ROUNDTABLE EVENT. (2020, August 5). Covid-19: Learning opportunity or setback? The Baldrige Institute. Retrieved from  

PODCAST. (2020, May 22). PSQH: The podcast episode 3 - Arizona Surge Line. Jay Kumar: Patient Safety & Quality Healthcare. Retrieved from

PODCAST. (2020, May 28). Field report: Arizona Surge Line in service of public health. Bill Russell: This Week in Health IT. Retrieved from

WEBINAR. (2021, April 8). View marriage of Acute and Community Care Panel. American Organization for Nursing Leadership. Retrieved from  

Curley, B. (2020, July 5). Covid-19: What it's like in hospitals in Texas and Arizona. Healthline. Retrieved from

Hagland, M. (2020, July 7). At Arizona’s Banner Health, Intricate Preparations for HandlingCOVID-19 Patient Surges Pay Off. Healthcare Innovation Group. Retrieved from  

King, R. (2020, July 27). Hospitals employ lessons learned in load balancing, supply chain as COVID-19 cases surge. FierceHealthcare. Retrieved from  

Leventhal, R. (2020, May 19). How Technology is Helping Arizona Healthcare Leaders Prepare for COVID-19 Surges. Healthcare Innovation. Retrieved from  

Siwicki, B. (2020, May 15). Arizona develops surge line for load-balancing COVID-19 cases. Healthcare IT News. Retrieved from

At the time of the Arizona Surge Line launch, Charley Larsen was the Senior Director of Banner Health Transfer Services. Today, he functions as the Co-Founder and Chief Nursing Officer of the healthcare consultant service, Blackbox Healthcare Solutions.