Assessment of Hospital Characteristics and Interhospital Transfer Patterns of Adults With Emergency General Surgery Conditions

Abstract

IMPORTANCE Although patients with emergency general surgery (EGS) conditions frequently undergo interhospital transfers, the transfer patterns and associated factors are not well understood. OBJECTIVE To examine whether patients with EGS conditions are consistently directed to hospitals with more resources and better outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study performed a network analysis of interhospital transfers among adults with EGS conditions from January 1 to December 31, 2016. The analysis used all-payer claims data from the 2016 Healthcare Cost and Utilization Project state inpatient and emergency department databases in 8 states. A total of 728 hospitals involving 85 415 transfers of 80 307 patients were included. Patients were eligible for inclusion if they were 18 years or older and had an acute care hospital encounter with a diagnosis of an EGS condition as defined by the American Association for the Surgery of Trauma. Data were analyzed from January 1, 2020, to June 17, 2021.EXPOSURES Hospital-level measures of size (total bed capacity), resources (intensive care unit[ICU] bed capacity, teaching status, trauma center designation, and presence of trauma and/or surgical critical care fellowships), EGS volume (annual EGS encounters), and EGS outcomes (riskadjusted failure to rescue and in-hospital mortality). MAIN OUTCOMES AND MEASURESThe main outcome was hospital-level centrality ratio, defined as the normalized number of incoming transfers divided by the number of outgoing transfers. A higher centrality ratio indicated more incoming transfers per outgoing transfer. Multivariable regression analysis was used to test the hypothesis that a higher hospital centrality ratio would be associated with more resources, higher volume, and better outcomes. RESULTS Among 80 307 total patients, the median age was 63 years (interquartile range [IQR], 50-75 years); 52.1% of patients were male and 78.8% were White. The median number of outgoing and incoming transfers per hospital were 106 (IQR, 61-157) and 36 (IQR, 8-137), respectively. A higher log-transformed centrality ratio was associated with more resources, such as higher ICU capacity (eg,

Association Between Time to Source Control in Sepsis and 90-Day Mortality

“…3,24 For all models, covariates were chosen a priori and included demographics (ie, age, sex, race, body mass index, Elixhauser Comorbidity Index), sepsis characteristics (ie, SOFA), intervention data (ie, physiologic stress, anatomic category 25 ), and hospital resources (ie, transfers, mandated surgeon availability, hospital admission year) and were clustered at the level of hospital. 26,27 We tested for a priori subgroup effects in the primary cohorts (ie, age, race, sex, SOFA, transfer status, surgeon availability, intervention physiologic stress, anatomic category) and most common intervention cohort (ie, intervention families). A P value for interaction <.05 defined significance and effect modification.…”

Operation of national coordinating service for interhospital transfer from emergency departments: experience and implications from Korea

“…Even if it is provided in real-time, some information may still be inaccurate and require manual verification. Second, it was recently argued that the information system should include quality indicators of the hospital, such as clinical outcomes and teaching status for optimizing transfer processes [ 2 , 3 , 16 , 17 ]. It is common to decide to transfer a patient to a hospital that can respond most quickly because there are few candidate hospitals that can receive emergency patients or the transfer arrangement itself is cumbersome [ 4 ].…”

Surgical Science and the Evolution of Critical Care Medicine

“…In fact, nearly one quarter of patients transferred for complex care underwent an antecedent surgical procedure (122). Additional system-level analysis is defining the regionalization of care for complex critically ill patients to ensure optimal outcomes—a process driven in part by the development of Acute Care Surgery services that provide rescue not only in the hospital but across a geographic service area (123, 124). The evolution of Acute Care Surgery has augmented surgical critical care by defining a specialty that attracts more surgeons to the field, improves the time to operative intervention and the quality of care for critically ill patients, and provides continuous coverage by specifically trained surgeons to support surgical rescue for the hospital and the regional healthcare system, while driving research to advance care.…”