Evaluation of interfacility transfer patterns among emergency general surgery patients.

Abstract

BackgroundInterfacility transfer for emergency general surgery (EGS) is a key strategy for improving access to care. However, low-intensity transfers with short stays and without procedural intervention are linked to increased costs, poor patient and family experience, and poor resource allocation. Clinical and health system characteristics associated with low-intensity transfers among patients with EGS conditions remain unclear. MethodsWe performed a cohort study among adults with EGS conditions using the 2021 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases from Florida and California. Lower-intensity transfers were defined as admissions ≤3 days with discharge to home without procedural intervention. We used multinomial logistic regression to identify patient and facility factors associated with lower-intensity transfers versus lower-intensity non-transfers. ResultsOf 211,466 patients presenting with EGS conditions, lower-intensity transfers encompassed 0.7% of encounters overall and 30% of transfers. Factors associated with lower-intensity transfer versus non-transfer included Medicaid insurance, history of bariatric surgery, patients presenting to a critical access hospital, and patients presenting with cholecystitis. Patients presenting to hospitals with advanced gastroenterology and palliative care were less likely to undergo lower-intensity transfer than lower-intensity non-transfer (p<0.05 for all). Discussion Facility characteristics are associated with transfers among EGS patients with SSA and may be a future target for policy aimed at optimizing regional EGS care. Understanding clinical and resource needs of EGS patients may facilitate the development of interventions to support EGS care in resource-limited settings and triage patients requiring high-complexity care to tertiary and quaternary facilities.