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  • Inter-hospital Transfer of Neurosurgical Patients to a High Volume Tertiary Care Center: Comprehensive Analysis and Opportunities for Process Improvement

    Final Number:

    Christopher Michael Holland MD PhD; Evan W. McClure; Brian M Howard MD; Owen B. Samuels MD; Daniel L. Barrow MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Indications for transfer of neurosurgical patients include absence of local or available neurosurgical coverage, subspecialty or interdisciplinary care requirements, and patient or family preference. The transfer of patients to regional centers is expected to increase with further regionalization of medical care. The transfer records of a large tertiary care medical center were explored to identify trends and opportunities to improve the transfer process.

    Methods: All consecutive, prospectively documented requests for inter-hospital patient transfer to the adult neurosurgical service of Emory University Hospitals were identified from a centralized transfer center database for a one-year, study period. Data was extracted from the transfer center database and the electronic medical record was reviewed for admitted patients.

    Results: Transfer requests for neurosurgical care constituted 1323 (14.6%) of the 9087, of which 81.1%, of these requests were accepted, and a total of 984 patients (74.4%) arrived at one of our institutions. Patients arrived from 133 unique referring facilities throughout a catchment area of 66,287 square miles. While the median travel time for transfer patients was 36 minutes, the median interval between the request and patient arrival was 4 hours 2 minutes. The most frequent diagnoses were intracranial hemorrhage (31.8%), subarachnoid hemorrhage (31.2%) and intracranial tumor (15.2%). The overall diagnostic error rate was 10.3%. Following admission, 42.5% of patients underwent neurosurgical intervention. Fifty-seven patients were inappropriately admitted to intensive care and were immediately transitioned to a lower level of care.

    Conclusions: Efficient and appropriate inter-hospital transfer requires a coordinated effort between hospital administration, physicians, and medical staff to make complex decisions that govern this important and costly process. These data suggest numerous opportunities for improvement exist, including: improved diagnostic accuracy, patient triage, and resource allocations, as well as more timely and efficient patient transfers.

    Patient Care: This research seeks to improve the care delivered to neurosurgical patients requiring transfer to tertiary care facilities by identifying strategies to eliminate process inefficiencies, reduce diagnostic errors, and appropriately allocate scarce healthcare resources.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the factors influencing inter-hospital patient transfer for neurosurgical care. 2) Understand the timing, justification, and disposition of transfer patients and how these factors affect patient care. 3) Identify strategies for improving the efficiency and timeliness of inter-hospital transfer of neurosurgical patients.


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