MODELS OF CARE CSIRO PUBLISHING

Australian Health Review, 2015, 39, 400–403 http://dx.doi.org/10.1071/AH14216

Inter-hospital lateral transfer does not increase length of stay Patrick Russell1,4 MD, FRACP, Consultant Physician Paul Hakendorf2 MPH, Clinical Epidemiologist Campbell Thompson3 MD, DPhil, Professor of General Medicine, Consultant Physician 1

Department of General Medicine, Flinders Medical Centre, 1 Bedford Drive, Bedford Park, SA 5042, Australia. Clinical Epidemiology Unit, Flinders Medical Centre, 1 Bedford Drive, Bedford Park, SA 5042, Australia. Email: [email protected] 3 University of Adelaide, Adelaide, SA 5000, Australia. Email: [email protected] 4 Corresponding author. Email: [email protected] 2

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. Received 7 November 2014, accepted 22 January 2015, published online 23 February 2015

Introduction Inter-hospital transfer of a patient can occur for a variety of reasons. An ‘up-transfer’ is undertaken to help critically ill medical or trauma patients access definitive care as quickly as possible.1 The safety and benefit of an inter-hospital transfer under these circumstances are clear. For example, moving a patient from a smaller hospital to a tertiary care centre for percutaneous coronary intervention or for post-thrombolysis care of acute ischaemic stroke is a well-established and indisputable pathway.2,3 If a patient is unsuited for discharge home Journal compilation  AHHA 2015

after stabilisation, then their transfer to a lower acuity facility, a ‘down-transfer’ for convalescence and rehabilitation, will also be preferred4 over remaining in the tertiary care centre. However, little is available to guide decisions of lateral transfer where the clinical services at the receiving hospital are equivalent to those from which the patient is being sent. Because clinical handovers often incur a break in continuity of care and possibly increase length of stay,5 we hypothesised that inter-hospital transfer of patients could result in a hospital stay that is longer than may have occurred in the absence of www.publish.csiro.au/journals/ahr

Inter-hospital lateral transfer

the lateral transfer. The aim of the present study was to determine whether the quality and efficiency of care provided to patients were adversely affected by their transfer. Since 2010, within an Australian urban regional health network, acutely unwell general medical in-patients have been transferred each day from one hospital frequently over capacity (Hospital A) to another (Hospital B), the latter having no emergency department (ED) but greater bed capacity to accommodate acutely unwell admissions. The two hospitals share many services, such as an imaging and laboratory database. The transfer process occurred 7 days a week, unless there were no beds available at Hospital B. Within 24 h of their arrival at Hospital A, patients were selected by a specialist general physician for transfer. A condition of transfer was that the patient did not need those services only available at Hospital A. Transfer was avoided for those patients thought to be at risk of imminent death or an early (

Inter-hospital lateral transfer does not increase length of stay.

The aim of the present study was to assess the effect of an inter-hospital transfer on efficiency and quality of in-patient care...
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