Challenges in arranging interhospital transfers from a small regional hospital: an observational study

To describe the process of interhospital transfer from a small regional hospital ED.

Prospective observational case series of patients transferred from the ED of West Gippsland Hospital (WGH), Victoria from February to August 2003. Outcome measures were expressed as the number of phone calls required to facilitate interhospital transfer, the time taken for a proposed transfer to be accepted and the total time a transferred patient spent in the ED.

Eighty-one of 129 transferred patients had all data available. Those with missing data had similar ED length of stays, and were of similar age and acuity to those with complete data available. Mean (95% CI) values for the study population were number of phone calls: 4.7 (95% CI 3.96-5.43); time to transfer acceptance: 56.7 min (95% CI 19.1-94.8 min); and total time in ED: 307 min (95% CI 32.9-372.6 min). Men (P = 0.01), older patients (P = 0.02) and those for whom a centralized referral service were consulted (P = 0.006) were more likely to require four or more phone calls to facilitate transfer. The time until a transfer was accepted was more likely to be longer than an hour for patients who were transferred to critical care areas (P = 0.02) and those for whom a centralized referral service was consulted (P = 0.002). Patients referred to another ED spent less time in WGH ED than other transferred patients.

There is wide variation in the time taken and the number of phone calls to arrange an interhospital transfer, with some patient groups requiring more effort to organize a transfer.