Emergency Department Transfers and Transfer Relationships in United States Hospitals

Abstract

Objectives: The objective was to describe transfers out of hospital-based emergency departments (EDs) in the United States and to identify different characteristics of sending and receiving hospitals, travel distance during transfer, disposition on arrival to the second hospital, and median number of transfer partners among sending hospitals.Methods: Emergency department records were linked at transferring hospitals to ED and inpatient records at receiving hospitals in nine U.S. states using the 2010 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases and State Inpatient Databases, the American Hospital Association Annual Survey, and the Trauma Information Exchange Program. Using the Clinical Classification Software (CCS) to categorize conditions, the 50 disease categories with the highest transfer rates were studied, and these were then placed into nine clinical groups. Records were included where both sending and receiving records were available; these data were tabulated to describe ED transfer patterns, hospital-to-hospital distances, final patient disposition, and number of transfer partners.Results: A total of 97,021 ED transfer encounters were included in the analysis from the 50 highest transfer rate disease categories. Among these, transfer rates ranged from 1% to 13%. Circulatory conditions made up about half of all transfers. Receiving hospitals were more likely to be nonprofit, teaching, trauma, and urban and have more beds with greater specialty coverage and more advanced diagnostic and therapeutic resources. The median transfer distance was 23 miles, with 25% traveling more than 40 to 50 miles. About 8% of transferred encounters were discharged from the second ED, but that varied from 0.6% to 53% across the 50 conditions. Sending hospitals had a median of seven transfer partners across all conditions and between one and four per clinical group.Conclusions: Among high-transfer conditions in U.S. EDs, patients are often transferred great distances, more commonly to large teaching hospitals with greater resources. The large number of transfer partners indicates a possible lack of stable transfer relationships between U.S. hospitals.ACADEMIC EMERGENCY MEDICINE 2015;22:157-165

Proactive review by the emergency department before inter‐hospital transfer (the PREVENT study)

“…Findings of this study that assessment of patients with mechanisms of acute trauma are a common cause of preventable transfer is consistent with previous reports. Among injured patients in a single trauma centre, 2000 patients per year were transferred and subsequently discharged from the second ED . Suspected traumatic spinal injuries, particularly of the cervical spine, are often transferred to tertiary trauma centres from other hospitals and subsequently discharged from the trauma centre's ED suggesting secondary over‐triage of such injuries.…”

“…In the USA, it has been reported that on average 8% of transferred patients were discharged after ED evaluation in the second hospital and a substantial proportion had short length of stays. Certain disease categories had significantly higher post‐transfer ED discharge rates, including acute trauma (13%) …”

The Transfer Instability Index: A Novel Metric of Emergency Department Transfer Relationships

“…We used the Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for 2010. A full explanation on how states were chosen, how ED transfer records were linked to inpatient or ED records at the receiving hospital, and how the study population was identified is elsewhere in this issue …”

Harnessing the Power of Administrative Data for Measuring the Regionalization of Emergency Care

“…In this issue of Academic of Emergency Medicine , two articles by Kindermann et al . provide the first comprehensive understanding of ED transfer patterns in the United States by taking advantage of this powerful AHRQ data from nine states.…”

“…In their study on ED transfer patterns, Kindermann et al. describe the variation in ED transfer rates for the most commonly transferred conditions, the characteristics of sending and receiving hospitals, the distances of transfer, the numbers of hospitals EDs transfer to, and the ultimate dispositions of patients transferred.…”