Waiting for definitive care: An analysis of elapsed time from decision to surgery or transfer in a rural centre

Abstract

Even in the absence of a strict four-hour rule program and a dedicated emergency surgical unit, main outcome measures appear to be comparatively efficient. However, the duration for transfer of patients is suboptimal because of the lack of established pathways for urgent non-trauma transfer from rural centres and bed availability in tertiary hospitals.

Interhospital transfer delays emergency abdominal surgery and prolongs stay

“…Median length of hospital stay was 20 and 13 days for transferred and direct admissions, respectively ( P < 0.001) . There were no significant differences in patient characteristics including age, sex, fracture type and fixation method between groups . A 2014 US study of paediatric burns patients also reported an association between interhospital transfer and increased length of stay independent of the percentage of total body surface area affected …”

“…Few Australian studies have examined the delays associated with interhospital transfer. A 2015 study of general surgical patients at a rural Victorian hospital found that a median 9.3 h elapsed between decision and execution of interhospital transfer . A primary reason for delay was lack of bed availability in the receiving hospital .…”

“…A 2015 study of general surgical patients at a rural Victorian hospital found that a median 9.3 h elapsed between decision and execution of interhospital transfer . A primary reason for delay was lack of bed availability in the receiving hospital . A 2007 Queensland study also found significant delays in decompressive craniotomy and increased mortality in patients with extradural haemorrhage who underwent interhospital transfer .…”

“…8 A primary reason for delay was lack of bed availability in the receiving hospital. 8 A 2007 Queensland study also found significant delays in decompressive craniotomy and increased mortality in patients with extradural haemorrhage who underwent interhospital transfer. 9 Similar results have been reported by several international studies.…”

Effect of in‐hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi

“…The rate of IHDs of 36·8 per cent in the present study was similar to that in an earlier study at a well staffed teaching hospital in Nigeria, where 50 per cent of patients waited over 24 h, and 16 per cent waited more than 48 h for operative intervention. At a regional hospital in Uganda 48 per cent of 31 operations were delayed (median delay 14·8 h), and in the Ivory Coast 86 per cent of patients had a delay of more than 24 h from symptom onset to surgery, with more than 36 per cent waiting over 48 h. Delays were defined in the present study as longer than 24 h. Most surgeons would agree that this is too long to wait for emergency care, and several other studies, especially in LMICs, have used this definition, although some high‐income countries (HICs) have used shorter times. Future research to measure specific time intervals, including time to decision to operate, time to diagnostic studies and exact times to procedures, should clarify the length of an acceptable in‐hospital wait.…”