A comparison of laboratory data in perinatal transfers at Baystate Medical Center and transferring hospitals

Objective: Perinatal transfers come to Baystate Medical Center (BMC), a tertiary hospital with level III nursery, for treatment of pregnancy-related complications such as preterm labor, PPROM, PIH, diabetes, and bleeding problems. We postulated that Baystate Medical Center, a teaching hospital, must repeat most of the laboratory tests ordered by the community hospitals transferring these pregnant patients.Methods: A comparison of laboratory tests ordered by the transferring hospital and Baystate Medical Center was done in a retrospective chart review. Among the 92 charts reviewed, 42 perinatal transfer patients with PTL and PPROM, excluding patients with diabetes, PIH, and other complications, were included in the study.Results: A significant difference (P <.001 by Student t test) was found between the number of laboratory tests ordered by Baystate Medical Center and the outside hospital. Ten laboratory tests, such as white count, hematocrit, differential, cervical cultures, urinalysis and culture, tox screen, type and screen, and ultrasounds, were ordered by BMC in comparison to only three laboratory tests ordered by the transferring doctors. In comparing patients directly admitted to Baystate for PTL or PPROM with the perinatal transfer patients, there was no significant difference between the number of laboratory tests ordered. However, perinatal transfers had a greater percentage of PPROM and delivery prior to 36 weeks.Conclusion: In conclusion, there is limited redundancy in laboratory testing in perinatal transfer patients when they are transferred from one institution to the another. Diagnosis of PTL is difficult and a panel of laboratory tests have become standards in finding causes at BMC. Allowing the tertiary hospital to work up the perinatal transfer patients is an efficient way of allocating health care.