Clinical ScienceInterhospital transfer for acute surgical care: does delay matter?

- Data from a retrospective cohort of 2,091 patient transfers from a 200+ hospital referral network.
- Delay in transfer request obtained from abstraction of referring facility records.
- Delays were more common for older patients and those with more comorbid conditions.
- Transfer delay was not associated with post-transfer mortality or hospice discharge.
- There is effective triage of high-risk patients.
- Further studies should explore other transfer processes and patient outcomes.

BackgroundDelays to definitive care are associated with poor outcomes after trauma and medical emergencies. It is unknown whether inter-hospital transfer delays affect outcomes for nontraumatic acute surgical conditions.MethodsWe performed a retrospective cohort study of patient transfers for acute surgical conditions within a regional transfer network from 2009 to 2013. Delay was defined as more than 24 hours from presentation to transfer request and categorized as 1 or 2+ days. The primary outcome was post-transfer death or hospice. Bivariate and multivariable logistic regression were performed.ResultsThe cohort included 2,091 patient transfers. Delays of 2 or more days were associated with death or hospice in unadjusted analyses, but there was no difference after adjustment. Predictors of post-transfer death or hospice included older age, higher comorbidity scores, and greater severity of illness.ConclusionsDelays in transfer request were not associated with post-transfer mortality or discharge to hospice, suggesting effective triage of nontraumatic acute surgical patients.