Capacity-related interfacility patient transports: patients affected, wait times involved and associated morbidity

The trend toward operating Canadian hospitals at full capacity necessitates in some settings the transfer of patients from one hospital's emergency department (ED) to another hospital for admission, due to lack of bed availability at the first hospital. Our objectives were to determine how many and which patients are transported, to measure how much time is spent in the peri-transport process and to document any morbidity or mortality associated with these periods of transitional care.

In this retrospective, observational health records review, we obtained health records during February, June and October 2002 for patients evaluated in any 1 of 3 adult EDs from a single Canadian city and subsequently transferred for admission to 1 of the other 2 hospitals. Data included the reason for transport, admitting service, transport process times and administration of key medications (asthma, cardiac, diabetes, analgesic or antibiotics).

Five hundred and thirteen records of transported patients were reviewed, and 507 were evaluated. Of those, 372 (73.4%) transfers were capacity-related and 135 (26.6%) were transferred for specialty services. Of the capacity transports, 219 (58.9%) were admissions for psychiatry and 123 (33.1%) for medicine. Median wait time at the first hospital was 6.7 hours, being longest for psychiatric patients. Thirty patients (8.1%) missed 1 or more doses of a key medication in the peri-transport process, and 8 (2.2%) missed 2 or more.

Overcrowding of hospitals is a significant problem in many Canadian EDs, resulting in measurable increases in lengths of stay. Transfers arranged to other facilities for admission further prolong lengths of stay. Increased boarding times can result in missed medications, which may increase patient morbidity. Further study is needed to assess the need for capacity transfers and the possible risk to patients associated with periods of transitional care.