R. C. Britt1, P. W. Davis1, T. J. Novosel1, J. N. Collins1, L. J. Weireter1, L. D. Britt1 1Eastern Virginia Medical School,Surgery,Norfolk, VA, USA
Introduction: Tertiary hospitals with the Acute Care Surgery(ACS) model are increasingly called on by smaller hospitals with fewer resources to assist in providing surgical care for complex patients. As well, there has been an increase in free standing emergency departments that require surgical consultation. This study was designed to assess the indications for transfer to the ACS service, including the demographics, patient factors, and outcomes.
Methods: The ER transfer logs as well as the Transfer Center logs at Sentara Norfolk General Hospital were reviewed for a 12 month period for all cases evaluated by the ACS service. The electronic medical record for each patient was then reviewed for demographics, comorbid conditions, and outcomes. Billing data was also reviewed to assess patient demographics. Statistical analysis was done using MedCalc© to determine significance.
Results:111 patients with complete data were identified, of which 59 transferred from a hospital and 52 from free-standing ER’s. Zip code analysis of billing data showed that 360/1080(33%)of ACS patients evaluated during the 12 month period were from more than 10 miles away, with no complete record of transfer for >200 patients. The patients transferred from another hospital were significantly older with more comorbid conditions, more likely to be discharged to a nursing home, and had a longer length of stay (Table 1). There was no difference between the two groups in time from evaluation to arrival at our institution or time from initial evaluation to operation. The patients from another hospital were more likely to be transferred for ‘higher level of care’ (78% vs. 4%, p<0.001), while the free-standing ER patients were more likely transferred for ‘surgical evaluation’ (94% vs. 15%, p<0.001). There was no difference in the percent of patients requiring a procedure (36 vs 29, p=0.73); however, significantly more of the procedures in the hospital transfer group were done by interventional radiology or GI (41% vs 10%, p=0.01). 6% of the patient had no insurance, but there were significantly more Medicare/Medicaid patients in the hospital transfer group (67% vs 35%, p=0.001)and significantly more private insured in the free-standing ER group (59% vs. 22%, p=0.001).
Conclusion:An increasingly complex patient population is being cared for in the tertiary hospitals, with significant difference in populations transferred from free standing ER’s versus other hospitals. The complexity of patients transferred into tertiary hospitals may have a significant impact on hospital outcomes. In the era of increasing scrutiny and pay for performance, better infrastructure to monitor the impact of hospital transfers is warranted.
