Delays to Initiate Interfacility Transfer for Patients Transported by a Critical Care Transport Organization

Area of Science:

• Critical Care Medicine
• Health Services Research
• Transport Medicine

Background:

• Interfacility transfer delays for critically ill patients are understudied.
• Timely transfer is crucial for definitive management.
• Identifying delay factors is essential for optimizing care.

Purpose of the Study:

• To identify patient, environmental, and institutional characteristics associated with delays in initiating interfacility transfers.
• To quantify the impact of these factors on transfer initiation time.

Main Methods:

• Retrospective cohort study of 11,231 adult patients undergoing interfacility transfer.
• Analysis of data from a provincial critical care transport organization over 3 years.
• Quantile regression used to explore factors influencing time to transfer initiation.

Main Results:

• Cardiac, gastrointestinal, respiratory, or sepsis-related transfers, vasopressor use, and evening transfers were associated with longer initiation times.
• Neurologic, obstetric, or trauma-related transfers, low Glasgow Coma Scale, blood transfusion needs, and smaller sending facilities were linked to shorter initiation times.
• Specific delays ranged from +1.45 to +4.90 hours for longer transfers and -0.98 to -3.14 hours for shorter transfers.

Conclusions:

• Time to initiate interfacility transfer is a modifiable delay in patient transport.
• Patient condition, transfer circumstances, and hospital size significantly impact transfer initiation times.
• Collaboration on bypass criteria and transfer agreements can expedite critically ill patient transfers.