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Am J Surg. 2016 Nov;212(5):823-830. doi: 10.1016/j.amjsurg.2016.03.004. Epub 2016 Jun 1.

Interhospital transfer for acute surgical care: does delay matter?

Author information

1
Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA; Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA; Department of Surgery, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA. Electronic address: kristy.l.kummerow@vanderbilt.edu.
2
Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
3
Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
4
Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA; Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
5
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
6
Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
7
Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA; Department of Surgery, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA.

Abstract

BACKGROUND:

Delays to definitive care are associated with poor outcomes after trauma and medical emergencies. It is unknown whether inter-hospital transfer delays affect outcomes for nontraumatic acute surgical conditions.

METHODS:

We performed a retrospective cohort study of patient transfers for acute surgical conditions within a regional transfer network from 2009 to 2013. Delay was defined as more than 24 hours from presentation to transfer request and categorized as 1 or 2+ days. The primary outcome was post-transfer death or hospice. Bivariate and multivariable logistic regression were performed.

RESULTS:

The cohort included 2,091 patient transfers. Delays of 2 or more days were associated with death or hospice in unadjusted analyses, but there was no difference after adjustment. Predictors of post-transfer death or hospice included older age, higher comorbidity scores, and greater severity of illness.

CONCLUSIONS:

Delays in transfer request were not associated with post-transfer mortality or discharge to hospice, suggesting effective triage of nontraumatic acute surgical patients.

KEYWORDS:

Acute care surgery; Death; Delay; Hospice; Inter-hospital; Quality; Transfer

PMID:
27381817
PMCID:
PMC5204367
DOI:
10.1016/j.amjsurg.2016.03.004
[Indexed for MEDLINE]
Free PMC Article

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