Interhospital transfers from U.S. emergency departments: implications for resource utilization, patient safety, and regionalization.

Objectives The authors sought to describe the demographic and clinical characteristics of interhospital transfers from U.S. emergency departments (EDs) along with the primary reasons for transfers. Methods This was a retrospective, cross-sectional analysis of the 1997 through 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS). Visit-level characteristics were compared for patients who were transferred, admitted, or discharged. Additionally, data on primary reason for transfer for available years (2005 through 2008) were reviewed. Weighted analyses produced nationally representative estimates. Results During this time period, 1.8% (95% confidence interval [CI] = 1.7% to 2.0%) of ED patients were transferred to other hospitals. Compared to visits resulting in admission, those resulting in transfer were more likely to involve patients who were <18 years old (18% vs. 7.9%), male (53% vs. 46%), with Medicaid (22% vs. 16%) or self-payment (15% vs. 8.2%) as a primary expected source of payment, having a visit related to injury (40% vs. 19%), and from a nonurban ED (29% vs. 15%). Among transferred patients, 28% (95% CI = 27% to 30%) received four to six diagnostic tests, and 31% (95% CI = 29% to 34%) received more than six diagnostic tests prior to transfer; 52% (95% CI = 50% to 54%) had diagnostic imaging, and 17% (95% CI = 16% to 19%) had cross-sectional imaging. Of the patients transferred from 2005 through 2008, 47% (95% CI = 43% to 53%) were transferred for a higher level of care, and 29% (95% CI = 26% to 35%) were transferred for psychiatric care. Conclusions Transfer of ED patients was relatively rare, but was more common among specific, potentially high-risk populations. Diagnostic testing, including advanced imaging, was common prior to transfer. A majority of transfers were for reasons indicating limited resources or expertise at the referring facility. Resumen Traslados Interhospitalarios de los Servicios de Urgencias y Emergencias en Estados Unidos: Implicaciones Respecto al Uso de Recursos, la Seguridad del Paciente y la Regionalizacion Objetivos Describir las caracteristicas demograficas y clinicas de los traslados interhospitalarios de los servicios de urgencias (SU) de Estados Unidos junto con las razones principales del traslado. Metodologia Analisis transversal retrospectivo de la National Hospital Ambulatory Medical Care Survey desde 1997 a 2009. Las caracteristicas del nivel de la visita se compararon para cada paciente que se traslado, ingreso o fue dado de alta. Ademas, se revisaron los datos de la razon principal para el traslado en los anos disponibles (2005 a 2008). Los analisis ponderados produjeron estimaciones representativas a nivel nacional. Resultados Durante el periodo del estudio, el 1,8% (IC 95% = 1,7% a 2,0%) de las visitas al SU se trasladaron a otro hospital. En comparacion con los ingresos, las visitas trasladadas se realizaron mas probablemente en pacientes menores de 18 anos de edad (18% vs. 7,9%), en varones (53% vs. 46%), en pacientes con Medicaid (22% vs. 16%) o con pago propio (15% vs. 8,2%) como fuente principal esperada de pago; en pacientes con una visita relacionada con una lesion (40% vs. 19%), y en los atendidos en un SU no urbano (29% vs. 15%). Entre las visitas trasladadas, un 28% (IC 95% = 27% a 30%) recibieron de cuatro a seis pruebas diagnosticas, y un 31% (IC 95% = 29% a 34%) recibieron mas de seis pruebas diagnosticas previas al traslado; un 52% (IC95% = 50% a 54%) tuvo una prueba de imagen, y un 17% (IC 95% CI = 16% a 19%) una imagen de cortes transversales. De los pacientes trasladados desde 2005 a 2008, un 47% (IC 95% = 43% a 53%) se trasladaron para una nivel de atencion mayor y un 29% (IC 95% = 26% a 35%) a un centro psiquiatrico. Conclusiones El traslado de pacientes del SU fue relativamente raro, pero mas comun en cierta poblacion potencialmente de alto riesgo. La realizacion de pruebas diagnosticas, incluidas las de imagen avanzada, fue frecuente previamente al traslado. Una mayoria de los traslados fueron por razones de recursos limitados o a un centro experto de referencia.