Inter-hospital lateral transfer does not increase length of stay
Patrick Russell A D , Paul Hakendorf B and Campbell Thompson CA Department of General Medicine, Flinders Medical Centre, 1 Bedford Drive, Bedford Park, SA 5042, Australia.
B Clinical Epidemiology Unit, Flinders Medical Centre, 1 Bedford Drive, Bedford Park, SA 5042, Australia. Email: paul.hakendorf@health.sa.gov.au
C University of Adelaide, Adelaide, SA 5000, Australia. Email: Campbell.thompson@adelaide.edu.au
D Corresponding author. Email: patrick.russell@health.sa.gov.au
Australian Health Review 39(4) 400-403 https://doi.org/10.1071/AH14216
Submitted: 7 November 2014 Accepted: 22 January 2015 Published: 23 February 2015
Abstract
Objective The aim of the present study was to assess the effect of an inter-hospital transfer on efficiency and quality of in-patient care.
Methods A retrospective cohort study from 2010 to 2012 inclusive was conducted in two tertiary-referral urban hospitals within a single area healthcare network. The study included 14 571 acutely unwell patients admitted to a general medical service. The main outcome measures were length of in-patient stay, relative stay index, readmission rate within 7 and 28 days of discharge and in-hospital mortality rate.
Results Compared with patients who were transferred to a long-stay ward within the original hospital (n = 3465), transferred patients (n = 1531) were older (71 vs 80 years, respectively; P < 0.001) but suffered less comorbidity (Charlson index 0.84 vs 1.22, respectively; P < 0.001). Transferred patients spent a shorter time in hospital (5.69 vs 6.25 days; P < 0.001) and were less likely to be re-admitted within 7 days (1.5% vs 4.0%; P < 0.001) or 28 days (6.3% vs 9.3%; P < 0.001) than patients who were not transferred. Mortality was lower in the transferred patients (1.1% vs 4.1%).
Conclusion Appropriate patients for inter-hospital transfer can be selected within 24 h of arrival at an index hospital. The efficiency of their care at the receiving hospital appears not to be compromised. The present study provides support for inter-hospital transfer as a strategy to optimise regional bed capacity.
What is known about the topic? Little has been written about lateral inter-hospital transfers; it was first labelled a ‘sideways transfer’ in a publication about hospital reimbursement published in the Medical Journal of Australia in 1998.
What does this paper add? This paper adds quality and safety data to what little is known about lateral transfers. ‘Lateral transfer’ better describes the process than ‘sideways transfer’.
What are the implications for practitioners? Our data helped us understand that a lateral transfer does not by itself increase the cost of the hospital stay, nor does it increase readmission rate or mortality. It also means that if a patient is hospitalised in a hospital with limited capacity and the patient’s acute medical problem has improved, but not resolved, that patient can be safely transferred to a hospital with available beds to continue receiving acute services.
References
[1] Hill AD, Fowler RA, Nathens AB. Impact of interhospital transfer on outcomes for trauma patients: a systematic review. J Trauma 2011; 71 1885–901.| Impact of interhospital transfer on outcomes for trauma patients: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22182900PubMed |
[2] Chew DP, French JF, Briffa TG, Hammett CJ, Ellis CJ, Isuru R, Aliprandi-Costa BJ, Astley CM, Turnbull FM, Lefkovits J, Redfern J, Carr B, Gamble GD, Lintern KJ, Howell EJ, Parker H, Tavella R, Bloomer SG, Hyun KK, Brieger DB. Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. Med J Aust 2013; 199 185–91.
| 23909541PubMed |
[3] Silverman IE, Beland DK, Chhabra J, McCullough LD. The ‘drip-and-ship’ approach: starting IV t-PA for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center. Conn Med 2005; 69 613–20.
| 16381108PubMed |
[4] Butt WW, Shann FA. Transferred patients: more complex and more costly? Med J Aust 1998; 169 42–3.
[5] Zwarenstein M, Bryant W. Interventions to promote collaboration between nurses and doctors. Cochrane Database Syst Rev 2002; 2 CD00072
[6] Charlson ME, Pompei P, Ales KL, MacKenzie RC. A new method of classifying prognostic comorbidity in longitudinal studies: developement and validation. J Chronic Dis 1987; 40 373–83.
| A new method of classifying prognostic comorbidity in longitudinal studies: developement and validation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2s7ms1GnsQ%3D%3D&md5=e8f9c1d14ab2168f63e2b9fa6f6becbfCAS | 3558716PubMed |
[7] Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43 1130–9.
| Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Crossref | GoogleScholarGoogle Scholar | 16224307PubMed |
[8] Australian Institute of Health and Welfare (AIHW). Hospital performance: relative stay index. AIHW; 2013. Available from: http://www.aihw.gov.au/haag09-10/hospital-performance-relative-stay-index/ [verified May 2014].
[9] Campbell D. Move to block hospital closures law backed by 20 coalition MPs. The Guardian. 11 Mar 2014. http://www.theguardian.com/society/2014/mar/11/hospital-closures-law-rebel-coalition-mps?INTCMP=ILCNETTXT3487 [verified May 2014].
