Related Experiment Videos
Community hospital transfers to a VA Medical Center
Abstract:
We prospectively studied all transfers from community hospitals to the Zablocki Veterans Administration Medical Center in Milwaukee (Wis) between May 28, 1986, and January 1, 1987. Transfers totaled 4.7% (311/6609) of acute-care admissions during the study period but accounted for 19.1% (39/204) of in-hospital deaths. The mortality rate for transferred patients who required Veterans Administration hospitalization was 12.5% (39/311) compared with 2.6% (165/6298) for all other admissions. At the time of transfer 59 patients (19%) were judged unstable by a modification of the APACHE II classification system, yet only 19 patients were cared for en route by a physician or a nurse. In addition to higher mortality, the transferred patients had a longer median length of stay than nontransferred patients (11 days vs 7 days).
Insights
Hospital transfers significantly increase patient mortality and length of stay. Unstable patients transferred often lacked adequate medical care en route, highlighting critical gaps in inter-facility patient transport protocols.
Area of Science:
- Medical Transfer Protocols
- Patient Outcomes Research
- Healthcare Systems Analysis
Background:
- Transfers from community hospitals to tertiary care centers are common.
- Assessing the impact of these transfers on patient outcomes is crucial for healthcare quality improvement.
Purpose of the Study:
- To evaluate the outcomes of inter-facility patient transfers.
- To identify factors contributing to adverse events in transferred patients.
Main Methods:
- Prospective study of all hospital transfers to a Veterans Administration Medical Center.
- Analysis of admission data, mortality rates, and length of stay.
- Utilized a modified APACHE II classification to assess patient stability at transfer.
Main Results:
- Transfers constituted 4.7% of admissions but 19.1% of in-hospital deaths.
- Mortality rate for transferred patients was 12.5% versus 2.6% for non-transferred patients.
- Unstable patients (19%) frequently lacked physician or nurse care during transport; transferred patients had longer hospital stays.
Conclusions:
- Inter-facility patient transfers are associated with significantly higher mortality.
- Inadequate medical support during transport may contribute to adverse outcomes.
- Healthcare systems need to improve transfer protocols, especially for unstable patients.