Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Young, Edward L.; Kopunic, Helena; Trochsler, Markus; Maddern, Guy J.

doi:10.1111/ans.17669

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…A recent systematic review by Young et al revealed that there remains a general paucity of knowledge regarding the factors influencing IHT delays 32 . A retrospective cohort study demonstrated modifiable predictors of IHT delay were inadequate clinical assessment, poor communication and multiple transfers 18 , similar to the highlighted themes identified during this thematic analysis.…”

Section: Discussionsupporting

confidence: 65%

“…A 2010 Cochrane review identified clinical pathway documents that link up-to-date evidence with specific health conditions are associated with reduced in-hospital complications and improved documentation without negatively affecting duration of hospital stay or cost 17 . A recent analysis of IHT patients using ANZASM data found that inadequate clinical assessment resulted in a 49.5-fold increased likelihood of transfer delay 18 , resulting in poorer patient outcomes 4 . Finally, important clinical management issues were identified associated with insufficient monitoring and a delay in recognizing complications.…”

Section: Discussionmentioning

confidence: 99%

“…Harl et al showed that a significant number of transfer notes in emergency general surgery patients were missing crucial clinical details, as well as radiological reports 30 . Poor communication has been associated with a greater than sixfold increase in the likelihood of delay in transfer 18 . As such, standardization of information exchange during transfer using a structured checklist may improve interhospital efficiency and patient safety.…”

Section: Discussionmentioning

confidence: 99%

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Surgical interhospital transfer mortality: national analysis

Murshed

Gupta

Camilos

et al. 2023

British Journal of Surgery

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Background Interhospital transfers of surgical patients are an independent risk factor for mortality. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) aims to improve surgical care through assessment of all cases of surgical mortality. This study aimed to describe common clinical management issues that contributed to interhospital transfer patient mortality. Methods Data for all surgical patient mortality in Australia (except New South Wales) that underwent interhospital transfer between 1 January 2010 and 31 December 2019 were extracted from ANZASM. The surgeons’ reports and assessors’ evaluations were examined to identify clinical management issues. Thematic analysis was performed to develop pertinent themes and subthemes. Results Some 8679 patients were identified over the 10-year period. Of these, 2171 (25.0 per cent) had 3259 clinical management issues identified. Prominent themes were operative design (n = 466, 14.3 per cent), decision to operate (n = 425, 13.0 per cent), medical conditions (n = 344, 10.6 per cent), diagnosis (n = 326, 10 per cent), transfer (n = 293, 10.0 per cent), intraoperative issues (n = 278, 8.5 per cent), inadequate assessment (n = 238, 7.3 per cent), communication (n = 224, 6.9 per cent), delay in recognizing complications (n = 180, 5.5 per cent), coagulopathy (n = 151, 4.6 per cent), insufficient monitoring (n = 127, 3.9 per cent), infection (n = 107, 3.3 per cent), and hospital resources (n = 100, 3.1 per cent). Assessors considered 58.4 per cent of clinical management issues (n = 1903) probably or definitely preventable. Conclusion This study identified 13 themes of potentially avoidable management issues present in surgical mortality following interhospital transfers. Quality-improvement initiatives targeting these areas may improve surgical patient outcomes.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical interhospital transfer mortality: national analysis

Murshed

Gupta

Camilos

et al. 2023

British Journal of Surgery

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“…This issue of the journal includes three papers on the topic of inter‐hospital transfers. The first is a 20‐year retrospective study of over 8000 surgical cases that that underwent transfer and who subsequently died 2 . Given the study was based on the Australian and New Zealand audit of surgical mortality (ANZASM), it could not report on the much larger number of transferred patients who survive.…”

mentioning

confidence: 99%

“…The first is a 20-year retrospective study of over 8000 surgical cases that that underwent transfer and who subsequently died. 2 Given the study was based on the Australian and New Zealand audit of surgical mortality (ANZASM), it could not report on the much larger number of transferred patients who survive. However, the authors identified both unmodifiable (gender and comorbidities) and modifiable predictors of delay (inadequate clinical assessment, poor communication and multiple transfers) and whether any delay contributed to death.…”

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confidence: 99%

Promoting good practice before, during and after transfers

Watters

Brown

2022

ANZ Journal of Surgery

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If the peri‐operative patient pathway was right, what would it look like?

Watters,

Scott,

Sammour

et al. 2024

ANZ Journal of Surgery

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BackgroundPatients undergoing surgery deserve the best possible peri‐operative outcomes. Each stage of the peri‐operative patient journey offers opportunities to improve care delivery, with shorter lengths of stay, less complications, reduced costs and better value.MethodsThese opportunities were identified through narrative review of the literature, with consultation and consensus at the hidden pandemic (of postoperative complications) summit 2, July 2023 in Adelaide, AustraliaResultsBefore surgery: Some patients who receive timely alternative treatments may not need surgery at all. The period of waiting after listing should be a time of preparation. Risk assessment at the time of surgical listing facilitates recognition of need for comorbidity optimisation and identifies those who will most benefit from prehabilitation, particularly frail and deconditioned patients.During surgeryDuring the surgical admission, ERAS programs result in less postoperative complications, shorter length of stay and better patient experience but require agreement between clinicians, and coordinated monitoring of delivery of the elements in the ERAS bundle of care.After surgeryAt‐risk patients need to have the appropriate levels of monitoring for cardiovascular instability, renal impairment or respiratory dysfunction, to facilitate timely, proactive management if they develop. Access to allied health in the early postoperative period is also critical for promoting mobility, and earlier discharge, particularly after joint surgery. Where appropriate, provision of rehabilitation services at home improves patient experience and adds value. The peri‐operative patient journey begins and ends with primary care so there is a need for clear communication, documentation, around sharing of responsibility between practitioners at each stage.ConclusionIdentifying and mitigating risk to reduce complications and length of stay in hospital will improve outcomes for patients and deliver the best value for the health system.

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Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Abstract: This paper is not based on any previous communications to a society or meeting. All authors had full access to all data, tables and statistical reports.

Cited by 5 publications

References 31 publications

Surgical interhospital transfer mortality: national analysis

Surgical interhospital transfer mortality: national analysis

Promoting good practice before, during and after transfers

If the peri‐operative patient pathway was right, what would it look like?

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