Potentially Avoidable Acute Care Patient Transfers to a Rural Academic Medical Center

Nair, Dilip; Gibbs, Mary; Gress, Todd; Barker, Shawndra

doi:10.21885/wvmj.2020.3

Cited by 3 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Diagnostic imaging especially CT was the most common reason for transfer, especially from those hospitals without local CT. This is consistent with international literature 22–24 . In a third of cases, CT was the sole investigation received at the urban hospital.…”

Section: Discussionsupporting

confidence: 90%

“…This is consistent with international literature. [22][23][24] In a third of cases, CT was the sole investigation received at the urban hospital. A quarter of transferred patients received a surgical intervention, and 10.2% were admitted to an ICU or an HDU.…”

Section: Overallmentioning

confidence: 99%

“…Access to diagnostics in rural areas is an important and well-described example of the health inequities that can affect rural populations. [34][35][36] Introducing diagnostic imaging modalities, such as CT, [22][23][24] has been shown to improve equity of access for rural patients both in NZ and internationally without an increase in overutilisation. 11,37 Where this is not possible, support needs to be provided for patients and their families, who are then transferred often vast distances away and in a different region from home.…”

Section: Policy Implicationsmentioning

confidence: 99%

See 2 more Smart Citations

A retrospective observational study examining interhospital transfers from six New Zealand rural hospitals in 2019

Miller

Rimmer²,

Blattner

et al. 2023

Australian J Rural Health

View full text Add to dashboard Cite

ObjectiveThe aim of this study was to identify the percentage of patients that were transferred from rural hospitals and who received an investigation or intervention at an urban hospital that was not readily available at the rural hospital.MethodsA retrospective observational study.DesignPatients were randomly selected and clinical records were reviewed. Patient demographic and clinical information was collected, including any interventions or investigations occurring at the urban referral hospital. These were compared against the resources available at the rural hospitals.SettingSix New Zealand (NZ) rural hospitals were included.ParticipantsPatients that were transferred from a rural hospital to an urban hospital between 1 Jan 2019 and 31 December 2019 were included.Main Outcome MeasuresThe primary outcome measure was the percentage of patients who received an investigation or intervention that was not available at the rural hospital.ResultsThere were 584 patients included. Overall 73% of patients received an intervention or investigation that was not available at the rural hospital. Of the six rural hospitals, there was one outlier, where only 37% of patients transferred from that hospital received an investigation or intervention that was not available rurally. Patients were most commonly referred to general medicine (23%) and general surgery (18%). Of the investigations or interventions performed, 43% received a CT scan and 25% underwent surgery.ConclusionsMost patients that are transferred to urban hospitals receive an intervention or investigation that was not available at the rural hospital.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Overallmentioning

confidence: 99%

Section: Policy Implicationsmentioning

confidence: 99%

See 1 more Smart Citation

A retrospective observational study examining interhospital transfers from six New Zealand rural hospitals in 2019

Miller

Rimmer²,

Blattner

et al. 2023

Australian J Rural Health

View full text Add to dashboard Cite

show abstract

“…Most hospitals routinely transfer patients with acute ICH to tertiary centers with neuro-ICUs, and stroke/ICH is one of the most common reasons for interhospital transfers from rural hospitals to academic medical centers. 31 Criteria on whether and when to transfer a patient to a higher level of care are often subjective and ill-defined and are often premised on the estimated risk of requiring a neurosurgical intervention; however, it remains unclear which factors and clinical features necessitate intensive care and transfer to a tertiary center. While critical for most patients, transfer or escalation of care for some patients may be unnecessary, delay treatment, and result in additional costs.…”

Section: Discussionmentioning

confidence: 99%

Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

et al. 2021

View full text Add to dashboard Cite

Objective:To develop a risk prediction score identifying intracerebral hemorrhage (ICH) patients at low risk for critical care.Methods:We retrospectively analyzed data of 451 ICH patients between 2010-2018. The sample was randomly divided in a development and a validation cohort. Logistic regression was used to develop a risk score by weighting independent predictors of ICU needs based on strength of association. The risk score was tested in the validation cohort, and externally validated in a dataset from another institution.Results:The rate of ICU interventions was 80.3%. Systolic blood pressure (SBP), Glasgow Coma Scale (GCS), intraventricular hemorrhage (IVH), and ICH volume were independent predictors of critical care, resulting in the following point assignments for the INtensive care TRiaging IN Spontaneous IntraCerebral hemorrhage (INTRINSIC) score: SBP 160-190 mm Hg (1 point), SBP >190 mm Hg (3 points); GCS 8-13 (1 point), GCS <8 (3 points); ICH volume 16-40 cm3 (1 point), ICH volume >40 cm3 (2 points); and presence of IVH (1 point), with values ranging between 0-9. Among patients with a score of 0 and no ICU needs during their emergency department stay, 93.6% remained without critical care needs. In an external validation cohort of ICH patients, the INTRINSIC score achieved an AUC of 0.823 (95% CI 0.782-0.863). A score <2 predicted absence of critical care needs with 48.5% sensitivity and 88.5% specificity, and a score <3 predicted absence of critical care needs with 61.7% sensitivity and 83.0% specificity.Conclusion:The INTRINSIC score identifies ICH patients at low risk for critical care interventions.Classification of Evidence:This study provides Class II evidence that the INTRINSIC score identifies ICH patients at low risk for critical care interventions.

show abstract

“…A recent publication of the use of poc-EEG in COVID-19 patients showed that for 10 consecutive device applications, mean time to interpretation was 23.8 min compared to 126.5 min for routine 18-channel studies ( 19 ). Before the advent of poc-EEG, many smaller hospitals would often transfer patients for these services; one study conducted in 24 West Virginia hospitals found that the need for critical care and neurology services accounted for nearly 54% of all transfers during their study period ( 20 ). Thus, there is clearly a need for and adaptation of poc-EEGs aimed at reducing the overall time to EEG as well as expanding EEG availability outside of tertiary care centers but data on this is limited.…”

Section: Discussionmentioning

confidence: 99%

Implementation and impact of a point of care electroencephalography platform in a community hospital: a cohort study

Ward,

Green,

Cole

et al. 2023

Front. Digit. Health

View full text Add to dashboard Cite

ObjectiveTo determine the clinical and financial feasibility of implementing a poc-EEG system in a community hospital.DesignData from a prospective cohort displaying abnormal mentation concerning for NCSE or rhythmic movements due to potential underlying seizure necessitating EEG was collected and compared to a control group containing patient data from 2020.SettingA teaching community hospital with limited EEG support.PatientsThe study group consisted of patients requiring emergent EEG during hours when conventional EEG was unavailable. Control group is made up of patients who were emergently transferred for EEG during the historical period.InterventionsApplication and interpretation of Ceribell®, a poc-EEG system.Measurement and main results88 patients were eligible with indications for poc-EEG including hyperkinetic movements post-cardiac arrest (19%), abnormal mentation after possible seizure (46%), and unresponsive patients with concern for NCSE (35%). 21% had seizure burden on poc-EEG and 4.5% had seizure activity on follow-up EEG. A mean of 1.1 patients per month required transfer to a tertiary care center for continuous EEG. For the control period, a total of 22 patients or a mean of 2 patients per month were transferred for emergent EEG. Annually, we observed a decrease in the number of transferred patients in the post-implementation period by 10.8 (95% CI: −2.17–23.64, p = 0.1). Financial analysis of the control found the hospital system incurred a loss of $3,463.11 per patient transferred for an annual loss of $83,114.64. In the study group, this would compute to an annual loss of $45,713.05 for an overall decrease in amount lost of $37,401.59. We compared amount lost per patient between historical controls and study patients. Implementation of poc-EEG resulted in an overall decrease in annual amount lost of $37,401.59 by avoidance of transfer fees. We calculated the amount gained per patient in the study group to be $13,936.44. To cover the cost of the poc-EEG system, 8.59 patients would need to avoid transfer annually.ConclusionA poc-EEG system can be safely implemented in a community hospital leading to an absolute decrease in transfers to tertiary hospital. This decrease in patient transfers can cover the cost of implementing the poc-EEG system. The additional benefits from transfer avoidance include clinical benefits such as rapid appropriate treatment of seizures and avoidance of unnecessary treatment as well as negating transfer risk and keeping the patient at their local hospital.

show abstract

Potentially Avoidable Acute Care Patient Transfers to a Rural Academic Medical Center

Cited by 3 publications

References 0 publications

A retrospective observational study examining interhospital transfers from six New Zealand rural hospitals in 2019

A retrospective observational study examining interhospital transfers from six New Zealand rural hospitals in 2019

Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

Implementation and impact of a point of care electroencephalography platform in a community hospital: a cohort study

Contact Info

Product

Resources

About