Evaluation of interfacility transfer patterns among patients with emergency general surgery conditions

Abstract

Background

Interfacility transfer for emergency general surgery is a key strategy for improving access to care. However, lower-intensity transfers are linked to increased costs, poor patient and family experience, and inefficient resource allocation. Clinical and health system characteristics associated with lower-intensity transfers among patients with emergency general surgery conditions remain unclear.

Methods

We performed a cohort study among adults with emergency general surgery conditions using claims data from Florida and California. Lower-intensity transfers were defined as admissions ≤3 days with discharge to home without procedural intervention. These were compared with greater-intensity transfers (admission >3 days, nonhome discharge, or procedural intervention), lower-intensity nontransfers, and higher-intensity nontransfers. We used multinomial logistic regression to identify patient and facility factors present on admission that were associated with lower-intensity transfer compared with other encounter types.

Results

Of 211,466 patients who underwent emergency general surgery, lower-intensity transfers encompassed 0.7% of encounters overall and 30% of transfers. Factors associated with lower-intensity transfer compared with nontransfer included Medicaid insurance, history of bariatric surgery, patients presenting to a critical access hospital, patients with cholecystitis, and patients presenting with higher-complexity surgical disease. Patients presenting to hospitals with advanced gastroenterology and palliative care were less likely to undergo lower-intensity transfer (P < .05 for all).

Conclusion

Facility characteristics are associated with lower-intensity transfers among patients who undergo emergency general surgery and may be a future target for policy aimed at improving the efficiency and quality of regional emergency general surgery care. Understanding clinical and resource needs of patients who undergo emergency general surgery may facilitate the development of interventions to support emergency general surgery care in resource-limited settings and triage patients requiring high-complexity care to tertiary and quaternary facilities.