Potentially Avoidable Acute Care Patient Transfers to a Rural Academic Medical Center

Though inter-facility acute care patient transfers from resource-limited rural hospitals are necessary, it is desirable to minimize them for several reasons. Some transfers might be potentially avoidable with appropriate pre-transfer teleconsultation. We conducted a retrospective record review of adult patient transfers to our rural academic medical center for medical-surgical services or critical care to estimate the frequency of potentially avoidable patient transfers and to identify any re-quested specialty that was more often associated withpotentially avoidable patient transfers. Excluded were patients transferred via trauma network or for obstetrics care. Transfers were judged potentially avoidable if resulting in live discharge within 48 hours without procedures or intensive care. We studied patient demographics and transferring facility characteristics.We examined 1,180 transfers between June 2016 and January 2017 and judged 21.6% (N=255) potentially avoidable. Transfers for Neurology consultation were 2.5 times (95% CI 1.2 -5.0) more likely to be avoidable relative to transfers for General Surgery. Neurology was the only specialty associated with a greater likelihood of potentially avoidable transfers than the comparator specialty.A significant proportion of inter-facility patient transfers to our facility are potentially avoidable. Neurology-related transfers might warrant pre-transfer teleconsultation.