Differentiating Interhospital Transfer Types: Varied Impacts and Diverging Coordination Strategies

Abstract

I nterhospital transfer (IHT) is common in care delivery. As a form of care transition, IHT faces coordination challenges and can negatively affect care outcomes. Understanding the underlying reasons and the associated operational challenges of different IHT types can help hospital managers design mitigation mechanisms to improve the IHT care outcomes. We conceptually and empirically differentiate between clinical and non-clinical transfers based on their unique characteristics and compare their respective impacts on care outcomes, including length of stay (LOS), readmission, and mortality. Non-clinical transfers are found to have worse care outcomes than clinical transfers and largely accounts for the inferior care outcomes of IHT compared with direct admissions, perhaps due to inadequate care coordination. Since poor coordination between hospitals is frequently cited as a root cause of care quality problems, we investigate whether two coordination mechanisms, namely hospital system affiliation and transfer routinization, can mitigate the potential negative effects of IHT on care outcomes. Our analyses suggest that the two coordination mechanisms are associated with improved IHT outcomes, and both seem to have stronger effects for non-clinical transfers. Specifically, system affiliation and transfer routinization can reduce LOS and readmission for non-clinical transfers. The results offer valuable insights to hospital managers for improving IHT care outcomes.

Stay at home to stay safe: Effectiveness of stay‐at‐home orders in containing the COVID‐19 pandemic

“…In the main analysis, we follow existing studies (see, e.g., Batt et al., 2019; Fan et al., 2021; Huang et al., 2021; Oh et al., 2018) by using propensity score matching to identify from the control and treatment groups a sample of counties that have similar baseline features and pretreatment outcomes. A potential concern is that individual counties have different pretreatment outcomes.…”

“…We follow existing studies (see, e.g., Batt et al., 2019; Fan et al., 2021; Huang et al., 2021; Oh et al., 2018) by using the propensity score matching method to address the curse of dimensionality. To describe this matching method, we denote by $$Feature_i$$ and $$NewCases_i$$ baseline features and pretreatment outcomes of county $$i$$, and $$StayAtHomeOrders_i$$ a dummy that indicates whether county $$i$$ implemented the stay‐at‐home order during our study period.…”

The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study

“…Others have reported large increases in LOS after intrahospital transfers, [11], [57] highlighting the importance of avoiding transfers where possible. Similarly, while the outcomes of patients following an inter-hospital transfer have been studied, [58], [59] the impact of a transfer to a hospital within a single trust has been unexplored. Our finding that such transfers are associated with a decrease in mortality suggests that localisation of specialist and general hospitals within a trust is a successful model of care, in the context of a large urban hospital trust.…”

Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients

“…Interhospital transfers of patients involve the complex and rapid coordination of clinical processes at two different hospitals. Most commonly, transfers occur because a patient's needs fall outside the scope of a hospital's level of care, requiring specialty surgical, subspecialty medical, or intensive care services 1 . Less commonly, patient preference or capacity constraints dictate the decision to transfer 2 .…”

“…Most commonly, transfers occur because a patient's needs fall outside the scope of a hospital's level of care, requiring specialty surgical, subspecialty medical, or intensive care services. 1 Less commonly, patient preference or capacity constraints dictate the decision to transfer. 2 Both formal (transfer of medical imaging) and informal (phone calls between providers) coordinating mechanisms facilitate moving a patient from one hospital to another.…”