Interhospital Transfer of Neurosurgical Patients: Implications of Timing on Hospital Course and Clinical Outcomes

Holland, Christopher M.; Lovasik, Brendan P.; Howard, Brian M.; McClure, Evan W; Samuels, Owen; Barrow, Daniel L.

doi:10.1093/neuros/nyw124

Cited by 24 publications

(13 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7 As a result, delays in the transfer of patients with sICH would result in worse outcomes. 8,9 At our urban, academic, tertiary care center, the neurocritical care unit (NCCU) is the preferable unit to receive sICH patients, especially those in need of EVD placement, from referring facilities. Historically, when there was no immediately available bed in the NCCU, patients were transferred to any adult intensive care unit (ICU) with an available bed.…”

Section: Introductionmentioning

confidence: 99%

Transfer of Patients with Spontaneous Intracranial Hemorrhage who Need External Ventricular Drain: Does Admission Location Matter?

et al. 2021

View full text Add to dashboard Cite

Introduction: Patients with spontaneous intracranial hemorrhage (sICH) are associated with high mortality and require early neurosurgical interventions. At our academic referral center, the neurocritical care unit (NCCU) receives patients directly from referring facilities. However, when no NCCU bed is immediately available, patients are initially admitted to the critical care resuscitation unit (CCRU). We hypothesized that the CCRU expedites transfer of sICH patients and facilitates timely external ventricular drain (EVD) placement comparable to the NCCU. Methods: This is a pre-post study of adult patients transferred with sICH and EVD placement. Patients admitted between January 2011-July 2013 (2011 Control) were compared with patients admitted either to the CCRU or the NCCU (2013 Control) between August 2013-September 2015. The primary outcome was time interval from arrival at any intensive care units (ICU) to time of EVD placement (ARR-EVD). Secondary outcomes included time interval from emergency department transfer request to arrival, and in-hospital mortality. We assessed clinical association by multivariable logistic regressions. Results: We analyzed 259 sICH patients who received EVDs: 123 (48%) CCRU; 81 (31%) 2011 Control; and 55 (21%) in the 2013 Control. The groups had similar characteristics, age, disease severity, and mortality. Median ARR-EVD time was 170 minutes [106-311] for CCRU patients; 241 minutes [152-490] (p < 0.01) for 2011 Control; and 210 minutes [139-574], p = 0.28) for 2013 Control. Median transfer request-arrival time for CCRU patients was significantly less than both control groups. Multivariable logistic regression showed each minute delay in ARR-EVD was associated with 0.03% increased likelihood of death (odds ratio 1.0003, 95% confidence interval, 1.0001-1.006, p = 0.043). Conclusion: Patients admitted to the CCRU had shorter transfer times when compared to patients admitted directly to other ICUs. Compared to the specialty NCCU, the CCRU had similar time interval from arrival to EVD placement. A resuscitation unit like the CCRU can complement the specialty unit NCCU in caring for patients with sICH who require EVDs.

show abstract

Section: Introductionmentioning

confidence: 99%

Transfer of Patients with Spontaneous Intracranial Hemorrhage who Need External Ventricular Drain: Does Admission Location Matter?

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Avoidance of interfacility transfer is associated with potential cost savings [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [22] . Arnold et al retrospectively reviewed the records of TBI patients with GCS 13–15 transferred to a level 1 trauma center in their respective hospital system.…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic brain injury (TBI) is a common reason for transfer to trauma centers for neurosurgical evaluation [1] , [2] , [3] , [4] , [5] , [6] . Results from a recent TRACK-TBI study revealed that less than 50% of patients with so-called “mild” TBI (i.e., Glasgow Coma Score (GCS), 13–15) reported full return to pre-injury levels of day-to-day function at one-year post-injury [7] , highlighting the need for further study of long-term functional limitations in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Inter-facility transfer of patients with traumatic intracranial hemorrhage and GCS 14–15: The pilot study of a screening protocol by neurosurgeon to avoid unnecessary transfers

Alan

Kim

Agarwal

et al. 2020

Journal of Clinical Neuroscience

View full text Add to dashboard Cite

show abstract

“…A previous study found that 17% of neurosurgical patients transferred to one hospital bypassed another neurosurgical center en route, and that in-transfer clinical decline occurred less frequently in patients who were transferred to the nearest neurosurgery center [3]. Furthermore, Holland et al demonstrated that the majority of transfers at their institution occurred at night despite a near equal number of requests during the daytime [1]. They also found that weekend transfers tended to have poorer outcomes than weekday transfers [1].…”

Section: Introductionmentioning

confidence: 99%

“…This holds true emphatically for neurosurgical patients, for whom both avoidable IHT and inefficient transfer infrastructure leave room for quality improvement. In one series of neurosurgical patients, 57.4% of IHT led to no surgical intervention and in another one 34.5% IHTs were non-operative [1,2]. The direct transportation costs for avoidable transfers amounted to $1.46 million over two years in a study of neurosurgical IHT [2].…”

Section: Introductionmentioning

confidence: 99%

Demographics and Outcomes of Interhospital Transfer Patients Undergoing Intracranial Tumor Resection: A Retrospective Cohort Analysis

Azizkhanian¹,

Matluck²,

Ogulnick³

et al. 2021

Cureus

View full text Add to dashboard Cite

IntroductionInterhospital transfer (IHT) contributes to increasing health care costs and typically accounts for increased patient morbidity and mortality compared to non-IHT patients. IHT inefficiencies leave patients vulnerable to delayed care and subsequent poor outcomes. In this study, we investigated factors influencing IHT of patients undergoing intracranial tumor resection (ITR), by comparing the variables distinguishing IHTs from non-IHT patients. MethodsWe performed a single-center retrospective review comparing IHT and non-IHT patients undergoing ITR from 2016 to 2018. Study variables included age, sex, race, the Milan Complexity Scale (MCS) score, 11factor modified frailty index (mFI-11), length of stay (LOS), and Clavien-Dindo Score (CDS). Chi-square and Mann-Whitney U tests were used to identify significant differences in these variables between groups, while variables predictive of transfer status were identified using binary logistic regression. ResultsData were collected from 219 patients undergoing ITR, with 80 (36.5%) IHT patients overall. The average age was 52 years (SD 18) and 57.7% were men. The MCS score was significantly higher in the IHT group (p = 0.014); however, mFI-11 was not (p = 0.322). The MCS score was predictive of IHT status in regression analysis (OR 1.17, p = 0.034). The IHT patients had a longer LOS (12 days vs 8 days, p = 0.014) with a lower CDS (p = 0.02). ConclusionThe transfer patients for intracranial tumor resection had a higher MCS score and thus comprised a more surgically challenging population compared to non-transfer patients. As expected, IHT patients had a longer LOS as they lived further from hospital by definition.

show abstract

Interhospital Transfer of Neurosurgical Patients: Implications of Timing on Hospital Course and Clinical Outcomes

Cited by 24 publications

References 53 publications

Transfer of Patients with Spontaneous Intracranial Hemorrhage who Need External Ventricular Drain: Does Admission Location Matter?

Transfer of Patients with Spontaneous Intracranial Hemorrhage who Need External Ventricular Drain: Does Admission Location Matter?

Inter-facility transfer of patients with traumatic intracranial hemorrhage and GCS 14–15: The pilot study of a screening protocol by neurosurgeon to avoid unnecessary transfers

Demographics and Outcomes of Interhospital Transfer Patients Undergoing Intracranial Tumor Resection: A Retrospective Cohort Analysis

Contact Info

Product

Resources

About