Interhospital transfer patients discharged by academic hospitalists and general internists: Characteristics and outcomes

Abstract

BACKGROUND Prior work suggests inter-hospital transfer (IHT) may be a risky event. Outcomes for patients transferred from another acute care institution and discharged by hospitalists and general internists at academic health systems are not well described. OBJECTIVE Investigate the characteristics and outcomes of IHT patients compared with patients admitted from the emergency department (ED) to academic health systems. DESIGN Retrospective cohort study. SETTING/PATIENTS 885,392 adult inpatients discharged by hospitalists or general internal medicine physicians from 158 academic medical centers and affiliated hospitals participating in the University HealthSystem Consortium Clinical Database and Resource Manager™ from April 1, 2011 to March 31, 2012. METHODS Patient cohorts were defined by admission source: those from another acute care institution were IHTs; those coming through the ED whose source of origination was not another hospital or ambulatory surgery site were ED admissions. In-hospital mortality was our primary outcome. We analyzed our data using descriptive statistics, t-tests, chi-square tests, and logistic regression. RESULTS Compared with ED admissions, IHT patients had a longer average length of stay, higher proportion of time spent in the intensive care unit, higher costs per hospital day, lower frequency of discharges home, and higher inpatient mortality (4.1% vs. 1.8%, p<0.01). After adjusting for patient characteristics and risk of mortality measures, IHT patients had a higher risk of in-hospital death (OR 1.36, 95% CI 1.29–1.43). CONCLUSIONS In this large national sample, IHT status is independently associated with inpatient mortality.

Interhospital transfer handoff practices among US tertiary care centers: A descriptive survey

“…In a prospective study, adverse events were found to occur during interhospital transfer up to 30% of the time . Furthermore, patients subject to interhospital transfer have longer length of stay and higher inpatient mortality, even after adjusting for mortality risk predictors . Standardizing intrahospital handoff structures and communication practices has been shown to reduce medical errors .…”

Interhospital transfers: The need for standards

“…Furthermore, unlike discharges home or to sub–acute care facilities, also known to be error prone and lead to adverse events, in the case of IHT, patients are often more acutely ill and less stable. In fact, limited data suggest that aside from a select subset of patients requiring specialized care, individuals transferred may have increased resource utilization and greater‐than‐expected mortality than those who are not transferred . Moreover, these findings may not be entirely attributable to medical complexity among transferred patients.…”

“…Today, the process of IHT varies tremendously across US hospitals, differences that may have significant implications for both cost and patient safety outcomes. Standardization of IHT, including patient selection and information exchange between transferring and accepting providers/institutions, is imperative to improve the quality and safety of this process.…”

An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010‐2015: Changing indications and lack of effect of hospital volume on inter‐hospital transfers

“…Transfer causes longer hospital stay and higher costs. For other surgical procedures, transfer imposes a higher risk of mortality, even when adjusted for patient mortality risk predictors . We found that about 15 children per year (0.12%) were transferred to another hospital, rather than discharged home.…”