The Emergency Medicine Treatment and Labor Act (EMTALA), passed by Congress in 1986, mandates that hospitals conduct a medical screening exam for all patients presenting for care in the emergency department (ED) regardless of their citizenship, legal status, or ability to pay. Hospitals vary widely in the services they offer to care for patients with acute and chronic medical problems. When a hospital does not have the ability or capacity to handle a patient’s condition, the decision often is made to transfer the patient to another acute care hospital.
Reasons for transfer are based on the patient’s clinical needs and the hospital’s available services and resources. Patients often are moved to specialty centers or to hospitals capable of providing higher levels of care that are not available in the original hospital. Transfer may be based on available specialty coverage; studies have shown increasingly sparse coverage for some specialties., In most cases, hospitals with specialized capabilities are obligated to accept transfers from hospitals that lack the capability to treat emergency medical conditions.
This Statistical Brief presents national estimates from the Healthcare Cost and Utilization Project (HCUP) on ED visits in 2009 and focuses on transfers out of EDs to other acute care hospitals. Patient factors such as age, sex, and primary expected payer, as well as hospital factors such as trauma level, teaching status, and ownership are examined with respect to patient disposition at discharge from the ED. We compare the distribution of ED transfers to other dispositions, including admission to the hospital and treatment and release from the ED. Transferred patients may have more in common with admitted patients than treat-and-release patients because they need a higher level of care prior to discharge. It is important to note that not all transferred patients are admitted after being evaluated in the receiving hospital’s ED; however, it was not possible to examine this issue in the current analysis. Several specific diagnostic categories also are explored, particularly with respect to rates of transfer. All differences between estimates noted in the text are statistically significant at the 0.05 level or better.