Acuity, outcomes, and trends in the transfer of surgical patients: a national study

Huntington, Ciara R.; Cox, Tiffany C.; Blair, Laurel J.; Prasad, Tanushree; Lincourt, Amy E.; Matthews, Brent D.; Heniford, B. Todd; Augenstein, Vedra A.

doi:10.1007/s00464-015-4361-0

Cited by 40 publications

(30 citation statements)

References 36 publications

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“…Evaluation of national patient databases indicate an increase in the proportion of interhospital transfers among EGS admissions in the United States by 150% between 2002 and 2011. 2 , 6 This practice burdens patients, who must travel long distances to obtain health care, as well as tertiary referral centers, who often suffer financially from caring for transferred patients. 10 Our study is the first to prospectively delineate circumstances prompting transfer to tertiary centers for EGS diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 , 12 Transfer patients generally have higher rates of comorbidities and a higher level of acuity, resulting in worse mortality and increased length of stay, compared to their directly admitted counterparts. 2 , 5 , 6 , 13 , 14 As a result, tertiary referral centers oftentimes suffer a net financial loss in caring for these patients, particularly in the setting of value-based reimbursement models. 10 Additionally, transfers over significant distances burden patients and their families during both the inpatient stay, as well as during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…Others argue that this difference in outcomes is small and that transfer patients represent a higher acuity population. 2 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

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An evaluation of emergency general surgery transfers and a call for standardization of practices

Bruenderman

Block

Kehdy

et al. 2021

Surgery

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Background There is an increasing trend toward regionalization of emergency general surgery, which burdens patients. The absence of a standardized, emergency general surgery transfer algorithm creates the potential for unnecessary transfers. The aim of this study was to evaluate clinical reasoning prompting emergency general surgery transfers and to initiate a discussion for optimal emergency general surgery use. Methods Consecutive emergency general surgery transfers (December 2018 to May 2019) to 2 tertiary centers were prospectively enrolled in an institutional review board–approved protocol. Clinical reasoning prompting transfer was obtained prospectively from the accepting/consulting surgeon. Patient outcomes were used to create an algorithm for emergency general surgery transfer. Results Two hundred emergency general surgery transfers (49% admissions, 51% consults) occurred with a median age of 59 (18 to 100) and body mass index of 30 (15 to 75). Insurance status was 25% private, 45% Medicare, 21% Medicaid, and 9% uninsured. Weekend transfers (Friday to Sunday) occurred in 45%, and 57% occurred overnight (6:00 pm to 6:00 am). Surgeon-to-surgeon communication occurred with 22% of admissions. Pretransfer notification occurred with 10% of consults. Common transfer reasons included no surgical coverage (20%), surgeon discomfort (24%), or hospital limitations (36%). A minority (36%) underwent surgery within 24 hours; 54% did not require surgery during the admission. Median length of stay was 6 (1 to 44) days. Conclusion Conditions prompting emergency general surgery transfers are heterogeneous in this rural state review. There remains an unmet need to standardize emergency general surgery transfer criteria, incorporating patient and hospital factors and surgeon availability. Well-defined requirements for communication with the accepting surgeon may prevent unnecessary transfers and maximize resource allocation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An evaluation of emergency general surgery transfers and a call for standardization of practices

Bruenderman

Block

Kehdy

et al. 2021

Surgery

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“…Inter‐hospital transfers are time‐consuming, complex and expensive. Preoperative inter‐hospital transfer in general surgical patients delays surgical intervention and these patients have worse outcomes, even when matched per operation and comorbidities . There has been a trend towards centralization of surgical services, however, this is often not appropriate in the setting of emergency surgery where delay to surgical intervention may be fatal .…”

Section: Discussionmentioning

confidence: 99%

Rural Emergency Laparotomy Audit

Watson

Maddern

Mudalige

et al. 2019

ANZ Journal of Surgery

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Background: Emergency laparoscopy/laparotomy is associated with high levels of mortality. The aim of this study was to determine whether outcomes following emergency laparoscopy/ laparotomy in rural and regional South Australian hospitals were comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit. Methods: A prospective multicentre audit of patients who undergo emergency laparoscopy/laparotomy. Participating hospitals included Mount Gambier and Districts Health Service, Whyalla Hospital and Riverland General Hospital. Inclusion and exclusion criteria were identical to the National Emergency Laparotomy Audit. A modified dataset for patients was collected if patients were up-transferred to another hospital prior to operative management. Data collected included patient demographics, operative management, adherence to processes of care and outcomes. Results: Data were collected for a total of 58 cases. Fifty-one of these had emergency laparoscopy/laparotomy in a rural or regional hospital and seven were transferred in the preoperative period. The median Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity predicted 30-day post-operative mortality was 3.5%. One hundred percent of patients (51 out of 51) had a consultant anaesthetist and surgeon present in the operating theatre. There were no deaths reported within the 30-day postoperative period. Conclusion: Outcomes following emergency laparoscopy/laparotomy in rural and regional South Australian hospitals are comparable to those reported in the National Emergency Laparotomy Audit and Perth Emergency Laparotomy Audit.

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“…[4][5][6][7][8][9][10] Limited studies in surgical patients have shown similar trends. [11][12][13][14][15] No prior studies examining interhospital transfer for conditions treated by otolaryngologists have been performed.…”

mentioning

confidence: 99%

The Association of External Transfer Status with Adverse Outcomes in Otolaryngology

Suresh

Gouveia

Kern

et al. 2018

Otolaryngol.--head neck surg.

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Objective To compare rates of morbidity and mortality in patients treated by otolaryngologists who undergo interhospital transfers vs those who do not and to quantify conditions requiring interhospital transfers in this population. Study Design Cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods We identified patients requiring surgery by otolaryngologists in the National Surgical Quality Improvement Program database from 2006 to 2013. We compared patients who were transferred from an outside institution to those admitted from home. Multivariate regression was used to adjust for patient characteristics, comorbidities, and case mix. The primary outcome was overall morbidity and mortality within 30 days of surgery. Results We identified 60,498 patients; 488 (0.8%) were transferred from another institution. Operations that were more common in the transferred group were incision and drainage (24.0% vs 1.2%), facial trauma repair (9.0% vs 3.1%), and oropharyngeal hemorrhage control (3.9% vs 0.4%). External transfer patients had significantly longer hospital stays (44.1% vs 4.4% >7 days, P < .05). On unadjusted analysis, transferred patients had a significantly higher rate of morbidity and mortality (odds ratio [OR], 11.3; 95% confidence interval [CI], 9.4-13.5). On multivariate analysis, transferred patients had a significantly greater rate of morbidity and mortality (OR, 3.1; 95% CI, 2.4-4.0). Conclusion Transfer from another institution is associated with worse outcomes independent of case mix, demographics, and preoperative comorbidities in acute otolaryngology conditions requiring surgery. Practitioners should be aware of this when caring for transfer patients, and transfer status should be considered when measuring hospital quality.

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Acuity, outcomes, and trends in the transfer of surgical patients: a national study

Cited by 40 publications

References 36 publications

An evaluation of emergency general surgery transfers and a call for standardization of practices

An evaluation of emergency general surgery transfers and a call for standardization of practices

Rural Emergency Laparotomy Audit

The Association of External Transfer Status with Adverse Outcomes in Otolaryngology

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