Timing, triage, and mode of emergency general surgery interfacility transfers in the United States: A scoping review

Abstract

Interfacility transfer of emergency general surgery (EGS) patients continues to rise, especially in the context of ongoing system consolidation. This scoping review aims to identify and summarize the literature on triage, timing, and mode of interfacility emergency general surgery transfer. While common, EGS transfer systems are not optimized to improve outcomes or ensure value-based care. We identified studies investigating emergency general surgery interfacility transfer using Ovid Medline, EMBASE, and Cochrane Library between 1990 and 2022. English studies that evaluated EGS interfacility timing, triage or transfer mode were included. Studies were assessed by two independent reviewers. Studies were limited to English-language articles in the United States. Data were extracted and summarized with a narrative synthesis of the results and gaps in the literature. There were 423 articles identified, of which 66 underwent full-text review after meeting inclusion criteria. Most publications were descriptive studies or outcomes investigations of interfacility transfer. Only six articles described issues related to the logistics behind the interfacility transfer and were included. The articles were grouped into the predefined themes of transfer timing, triage, and mode of transfer. There were mixed results for the impact of transfer timing on outcomes with heterogeneous definitions of delay and populations. Triage guidelines for EGS transfer were consensus or expert opinion. No studies were identified addressing the mode of interfacility EGS transfer. Further research should focus on better understanding which populations of patients require expedited transfer and by what mode. The lack of high-level data supports the need for robust investigations into interfacility transfer processes to optimize triage using scarce resources and optimized value-based care.

European society for trauma and emergency surgery member-identified research priorities in emergency surgery: a roadmap for future clinical research opportunities

“…Moreover, robust data collection should be routine in an ideal EGS system and will support Quality Improvement (QI) as well as an EGS standards verification process for Europe mirrored on the nascent American College of Surgeons Emergency General Surgery Verification Program (EGS-VP) [ 31 – 33 ], a new program paralleling the American College of Surgeons Committee on Trauma (ACS COT) trauma center verification approach [ 33 ]. In our current era of organ-specific or process specific surgeons interfacility transfers for EGS expertise have increased by approximately 150% in the United States over the past decade [ 34 , 35 ]; there are no comparable contemporary data for Europe to inform policymakers. While coordinated inter-hospital transfer systems have been associated with a 9.7% decrease in EGS patient mortality, regionalization presents a variety of challenges, some of which may be related to finances, hospital systems, surgeon biases or desires, as well as patient preferences for specific care locations or care clinicians [ 24 ]…”

Association between timing of operative interventions and mortality in emergency general surgery

“…First, the absence of established, evidence-based triaging systems for prioritizing EGS cases underscores the need for further research. 45 Our study can provide a foundational starting point for developing such systems, helping healthcare providers make more informed decisions regarding case prioritization and resource allocation. Second, the substantial variation in EGS practices highlights the importance of our findings.…”