Comparison of Interhospital Urological Transfers between a Metropolitan and Rural Tertiary Care Institution

Urological services are not available at all hospitals and the transfer of patients between medical centers provides an avenue to meet medical need. In rural areas patients often visit community medical centers with limited services and require transfer. We compared the transfer process between 2 tertiary care institutions, one serving a metropolitan population and the other a rural population.

Two academic medical centers were selected, with one that primarily services a large metropolitan city center and one that primarily services a large rural population. Transfer logs for the urological services from September 2015 to September 2017 were compared. Records were examined for an affiliated urologist at the originating hospital, distance traveled, reason for transfer and the need for surgical management. Variables were analyzed using descriptive statistics.

Overall 606 transfers were included in the study, with 16% (97) transferred to the metropolitan center and 84% (509) transferred to the rural center. Patients transferred to the rural center were younger (53.3 vs 61.9 years, p <0.001) and traveled further (64.2 vs 36.5 miles, p <0.001) compared to the metropolitan site. Hospitals referring patients to the rural center were less likely to have an affiliated urologist (66.7% vs 91.1%, p=0.008). Overall 38% of patients were treated surgically, which was not different between the institutions.

Differences exist between transfers to the rural and the metropolitan center, suggesting an increased need for basic urological services in the surrounding rural community. At both centers most patients did not require a procedure and might avoid transfer through telehealth or collaborative care networks.