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  • Time-trend Analysis of Patient Transfers to a Neurosurgical Service at a Tertiary Care Facility in the Southeastern United States

    Final Number:

    David LaBorde MD; Jaskaran Rakkar BS; Nathaniel Bloodworth BS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Tertiary acute care hospitals (TACH) staffed with neurosurgeons are a critical resource and are often centers of last resort for patients in need of urgent and emergent neurosurgical intervention presenting to hospitals in the community without a neurosurgeon on call. This analysis examines neurosurgical transfers to a large TACH in the southeast with 24 hr neurosurgical coverage 7 days per week. Herein factors are examined which may affect transfer volumes to this accepting facility (AF), including distance to the AF, month, and arrival time.

    Methods: Deidentified AF transfer center data from 11/2009 to 01/2011 was examined retrospectively. Transfer date and time, volumes, and the identity of the in-state referring hospitals (RHs) were examined. RHs were ranked by volume and divided into 5 tiers. Tier 1 RHs sent the highest number of patients and Tier 5 RHs sent the least. Driving distances were computed. ANOVA and Tukey-Kramer testing determined significance.

    Results: 1,050 patients were sent to the AF by 85 RHs during the time period analyzed. 57% and 82% of transfers came from Tier 1 and Tiers 1-2, respectively. Tier 1 RHs were significantly closer (p<0.05) to the AF than all other groups except for Tier 2 RHs. The proportion of annual transfers by month ranged from a high of 9.8% to a low of 7.4% in October and April, respectively. The AF received a significantly fewer number of transfers between 00:00 and 07:59 hours versus 12:00 and 23:59 hours (p<0.05).

    Conclusions: A framework for analyzing neurosurgical patient transfers to TACHs is presented. Results indicated that the majority of neurosurgical patient transfers (>80%) came from RHs close (< 50 miles) to the AF during the hours of 12:00 and 19:59. This may have implications for staffing levels, managing relationships with top RHs, and investing in health information exchange.

    Patient Care: Provide insight into factors that impact neurosurgical patient transfers to tertiary care facilities.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Describe methods for analyzing patient transfer volumes to institutions with neurosurgeon on call at all times. 2. Discuss and quantity factors that impact the patient transfer volumes during inter-hospital transfers. 3. Utilize the findings from this investigation to develop models that may help optimize transfer protocols.


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