TCT-50 Fiscal Impact of Avoiding Unnecessary Transfers and Hospitalization in STEMI Interventions– Results from Latin America Telemedicine Infarct Network (LATIN)

Mehta, Sameer; Botelho, Roberto; Fernández, Francisco; Prudente, Maurício; Cavalcanti, Ricardo; Cade, Jamil; Dusilek, Cesar; Feres, Fausto; Alcocer-Gamba, Marco A; Estrada, Alfredo; Torres, Mario; Rodriguez, Daniel

doi:10.1016/j.jacc.2018.08.1136

Cited by 2 publications

(1 citation statement)

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“…This service has been most broadly implemented in telestroke care, providing real-time video consultation by a neurologist to an ED for the purpose of selecting patients for intravenous thrombolysis [32]. In some cases, inter-facility transfers have been avoided with targeted remote care [33][34][35][36] and allowed patients to remain near their families [37],which suggests that specialty telehealth capabilities may improve access, timeliness, and reduce the need for some emergency inter-facility transfers [23]. Some reports have even reported favorable provider-based outcomes related to telehealth implementation [38,39].…”

Section: Discussionmentioning

confidence: 99%

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Mohr

Ward

et al. 2020

BMC Health Serv Res

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Background: Inter-facility transfer is an important strategy for improving access to specialized health services, but transfers are complicated by over-triage, under-triage, travel burdens, and costs. The purpose of this study is to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. Methods: This observational cohort study included all patients treated in VHA EDs between 2012 and 2014 who were transferred to another VHA hospital. Potentially avoidable transfers were defined as patients who were either discharged from the receiving ED or admitted to the receiving hospital for ≤1 day without having an invasive procedure performed. We conducted facility-and diagnosis-level analyses to identify subgroups of patients for whom potentially avoidable transfers had increased prevalence. Results: Of 6,173,189 ED visits during the 3-year study period, 18,852 (0.3%) were transferred from one VHA ED to another VHA facility. Rural residents were transferred three times as often as urban residents (0.6% vs. 0.2%, p < 0.001), and 22.8% of all VHA-to-VHA transfers were potentially avoidable transfers. The 3 disease categories most commonly associated with inter-facility transfer were mental health (34%), cardiac (12%), and digestive diagnoses (9%). Conclusions: VHA inter-facility transfer is commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.

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