Inter-facility Patient Transfers in Ontario: Do You Know What Your Local Ambulance Is Being Used For?

Abstract

Background: Little is known about inter-facility patient transfers in populations. In 2003, detailed information about inter-facility patient transfers began to be systematically collected in Ontario. Methodology: The authors undertook a descriptive examination of inter-facility patient transfers using a newly created population-based information system. Results: Approximately 1,000 inter-facility patient transfers occur in Ontario each day, and every day and a half, the total distance travelled for these transfers equals the distance around the earth' s circumference. The annual cost for patient transfers is approximately $283 million. Most common were routine and non-urgent inter-facility patient transfers. Eighty-five thousand patients (24.3% of transferred patients) were transported between healthcare facilities for dialysis appointments, appointments with physicians and return trips home. Patients with circulatory conditions were the most commonly transferred diagnostic group. Although 70% of all transfers were within 25 kilometres, some were for longer distances: for example, those involving pregnant women and newborn babies required travelling a median distance of 40.3 kilometres for continued care. Cardiac patients (54,000 patient transfers per year) travelled a median of 24.2 kilometres to reach a catheterization lab for treatment and further investigation. There was considerable lateral movement between academic health sciences centres (AHSCs). Over 16,000 patients per year (4.7% of all transfers) were transferred from one AHSC to another, predominantly for cardiac care. Discussion: Patients in Ontario are often transferred between healthcare facilities. Most transfers are for routine, non-life-threatening reasons, using the Emergency Medical Services (EMS) system. This practice diverts resources from more emergent requests. Although patient transportation is a necessary part of any healthcare system, the results of this study highlight the current demands on a system that was not intended for the volume of inter-facility patient transfers it is supporting. These results call into question the use of sophisticated, highly trained, expensive patient transfer resources to provide routine medical services in Ontario.

Évolution des transferts interhospitaliers au départ d'un centre hospitalier universitaire suisse

“…Traditionnellement, ces transferts étaient réalisés afin d'avoir accès à une compétence spécialisée dans un centre hospitalier de niveau supérieur (neurochirurgie, cardiologie invasive, radiologie interventionnelle, dialyse, etc.) [1][2][3][4]. Ce concept de transferts centripètes concerne en particulier les patients traumatisés, nécessitant un trauma center, dans le cadre d'une organisation globale de soins (trauma system) visant à optimiser leur prise en charge et dès lors leur devenir [5].…”

“…Paradoxalement, les transferts interhospitaliers sont organisés actuellement de plus en plus souvent en raison du manque de disponibilités en lits d'accueil dans les hôpitaux, ou pour des raisons économiques [3,6]. L'augmentation du recours aux services d'urgence et aux structures hospitalières, le vieillissement de la population et la diminution de la densité médicale dans les régions rurales favorisent ainsi une suroccupation des établissements hospitaliers urbains et des centres universitaires, avec une augmentation des transferts centrifuges.…”

“…L'augmentation du recours aux services d'urgence et aux structures hospitalières, le vieillissement de la population et la diminution de la densité médicale dans les régions rurales favorisent ainsi une suroccupation des établissements hospitaliers urbains et des centres universitaires, avec une augmentation des transferts centrifuges. Cet engorgement est particulièrement préoccupant dans les services d'urgences, de réanimation ou dans les unités d'hospitalisations aiguës, où les politiques de rationalisation des structures de soins et de maîtrise des coûts de la santé ont favorisé une réduction du nombre de lits au cours de ces dernières décennies [3]. La multiplication des transferts n'est donc plus ici le reflet d'une prise en charge médicale.…”

“…Dans la plupart des pays occidentaux, les transferts sont assurés par les structures d'urgence préhospitalières du quotidien (ambulances, hélicoptères de sauvetage) ou sous-traités à des entreprises privées dans le cadre de contrats de collaboration [1,3]. Une part significative de ces transferts concerne des patients instables, avec des équipements et des traitements de soins intensifs, impliquant un risque accru de complications et de mortalité durant le transport [7].…”

Can a single primary care paramedic configuration safely transport low-acuity patients in air ambulances?

“…The development of regionalized health care in Canada has made it necessary to rely on ambulance programs for transport between facilities providing different levels of medical care. 1 Most land and air ambulance programs in Canada require a two-person medical crew, and their regulations are based on literature suggesting that the dual provider configuration is safer. [2][3][4][5][6][7][8][9][10][11][12][13] In general, however, the evidence for these recommendations is not extensive and somewhat dated.…”