Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation

Mueller, Stephanie; Zheng, Jing; Orav, E. John; Schnipper, Jeffrey L.

doi:10.12788/jhm.2747

Cited by 46 publications

(93 citation statements)

References 28 publications

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“…First, given the criteria we used to define transfer, it is possible that we included nontransferred patients within our transferred cohort if they were discharged from one hospital and admitted to a different hospital within 1 day, although quality assurance analyses we conducted in prior studies on these data support the validity of the criteria used. 2 Second, we cannot exclude the possibility that patients received nonprocedural specialty care (ie, expert opinion, specialized imaging, medical management, management of secondary diagnoses, etc.) not available at the transferring hospital, although, arguably, in select patients, such input could be obtained without physical transfer of the patient (ie, tele-consult).…”

Section: Discussionmentioning

confidence: 99%

“…© 2018 Society of Hospital Medicine we used in our prior research. 2 Beneficiaries transferred to the same hospital, those with greater than 1 transfer within the same hospitalization, or those cared for at hospitals with "outlier" transfer-in rates equal to 100% or transfer-out rates greater than 35% were excluded from analysis given the suggestion of nonstandard claims practices.…”

Section: Methodsmentioning

confidence: 99%

“…6 More recent data suggest variability in hospital transfer practices not accounted for by differences in patient or hospital characteristics. 2 Although disease-specific guidelines for IHT exist for certain diagnoses, 3,4 the process remains largely nonstandardized for many patients, 7 leading to ambiguity surrounding indications for transfer. Because limited data suggest worse outcomes for transferred versus nontransferred patients, 8 a better understanding of the specialized care patients actually receive across the transfer continuum may help to elucidate potential indications for transfer and ultimately help delineate which patients are most (or least) likely to benefit from transfer and why.…”

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confidence: 99%

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Interhospital Transfer and Receipt of Specialty Procedures

Mueller

Zheng

Orav

et al. 2017

Journal of Hospital Medicine

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The practice of transferring patients between acute care hospitals is variable and largely nonstandardized. Although often-cited reasons for transfer include providing patients access to specialty services only available at the receiving institution, little is known about whether and when patients receive such specialty care during the transfer continuum. We performed a retrospective analysis using 2013 100% Master Beneficiary Summary and Inpatient claims files from Centers for Medicare and Medicaid Services. Beneficiaries were included if they were aged =65 years, continuously enrolled in Medicare A and B, with an acute care hospitalization claim, and transferred to another acute care hospital with a primary diagnosis of acute myocardial infarction, gastrointestinal bleed, renal failure, or hip fracture/dislocation. Associated specialty procedure codes (International Classification of Diseases, Ninth Revision, Clinical Modification) were identified for each diagnosis. We performed descriptive analyses to compare receipt of specialty procedural services between transferring and receiving hospitals, stratified by diagnosis. Across the 19,613 included beneficiaries, receipt of associated specialty procedures was more common at the receiving than the transferring hospital, with the exception of patients with a diagnosis of gastrointestinal bleed. Depending on primary diagnosis, between 32.4% and 89.1% of patients did not receive any associated specialty procedure at the receiving hospital. Our results demonstrate variable receipt of specialty procedural care across the transfer continuum, implying the likelihood of alternate drivers of interhospital transfer other than solely receipt of specialty procedural care.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Interhospital Transfer and Receipt of Specialty Procedures

Mueller

Zheng

Orav

et al. 2017

Journal of Hospital Medicine

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“…Our study is subject to several limitations. This is a single site study; given known variation in transfer practices between hospitals, 3 it is possible that our findings are not generalizable. However, given similar existing data on patients admitted through the ER, it is likely our findings may be reflective of IHT to similar tertiary referral hospitals.…”

Section: Discussionmentioning

confidence: 94%

Interhospital Transfer: Transfer Processes and Patient Outcomes

Mueller

Fiskio

Schnipper

2019

Journal of Hospital Medicine

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Though often undertaken to provide patients with specialized care, interhospital transfer (IHT) is associated with worse outcomes for select patients. Certain aspects of the transfer process have been suggested as contributors to these outcomes. We performed a retrospective cohort study including patients ≥ 18 years who underwent IHT to a tertiary care hospital between January 2005 and September 2013. We examined the association between “weekend” transfer, “nighttime” transfer, “time delay” between transfer acceptance and arrival, and admission team “busyness” on the day of transfer, and patient outcomes, including transfer to the intensive care unit (ICU) within 48 hours and 30-day mortality. We utilized multivariable logistic regression models, adjusting for patient characteristics. Secondary analyses examined detailed timing of transfer and evaluated 30-day mortality stratified by service of transfer. Among the 24,352 patients who underwent IHT, the nighttime transfer was associated with increased adjusted odds of ICU transfer (odds ratio [OR] 1.54; 95% CI 1.38, 1.72) and 30-day mortality (OR 1.16; 95% CI 1.01, 1.35). Secondary analyses confirmed the association between nighttime transfer and ICU transfer throughout the week and demonstrated that Sunday (and trend towards Friday) night transfers had increased 30-day mortality, as compared with Monday daytime transfer. Stratified analyses demonstrated a significant association between transfer characteristics and adjusted odds of 30-day mortality among cardiothoracic and gastrointestinal surgical service transfers. Our findings suggest high acuity patients have worse outcomes during off-peak times of transfer and during times of high care team workload. Further study is needed to identify underlying reasons to explain these associations and devise potential solutions.

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“…A study using the American College of Surgeons National Surgery Quality Improvement Program found that interhospital transfer is an independent risk factor for mortality, morbidity, and high resource utilization [9] . These worse outcomes could be due to delay in diagnosis and initiation of transfer, availability of bed space in the receiving hospital, medical errors from transition of care, and the complex logistics of IHT [10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Impact of Transfer Status on Outcomes in Hospitalized Patients with Hepatorenal Syndrome

Chris-Olaiya¹,

Ajose

Ohadugha³

et al. 2019

Journal of Gastroenterology and Hepatology Research

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AIM: To examine the impact of transfer status on outcomes in patients hospitalized with hepatorenal syndrome (HRS) at the population level. MATERIALS AND METHODS: Using a national database, we performed a retrospective study on all adult (≥ 18 years) with HRS between 2012-2014. All hospitalizations involving any form of chronic kidney disease were excluded. The primary outcome was inhospital mortality and the secondary outcomes were chronic liver disease complications, procedure utilization, length of hospital stay, and hospitalization, cost. Outcomes were compared between those who were directly admitted and those who were transferred from another hospital. RESULTS: 49,190 hospitalizations met the inclusion criteria with 8,160 (16.5%) in the transfer group. The transfer group had higher mortality (41.5% vs 36.0%). On multivariate logistic regression, the transfer group had significantly higher odds of mortality (odds ratio [

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Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation

Cited by 46 publications

References 28 publications

Interhospital Transfer and Receipt of Specialty Procedures

Interhospital Transfer and Receipt of Specialty Procedures

Interhospital Transfer: Transfer Processes and Patient Outcomes

Impact of Transfer Status on Outcomes in Hospitalized Patients with Hepatorenal Syndrome

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