Introduction: Interfacility neurosurgical transfers to tertiary care centers are driven by a number of variables including lack of on-site coverage, limited technology, insurance, and patient preference. We sought to assess the timing and necessity of surgery and compare transfers from Emergency Departments (ED) and inpatient units.
Methods: Non-traumatic adult neurosurgical transfers to a single tertiary care center were analyzed over 12 months.
Results: 504 transfer patients were accepted with mean age 55 years (range=19-92) and 53% women. Points of origin were ED in 54% and inpatient hospital unit in 46% with mean distance travelled of 119 miles. Broad diagnosis categories included brain tumors (n=142; 28%), vascular lesions or intracerebral hemorrhage (ICH) (n=143; 28%), spinal lesions (n=126; 25%), hydrocephalus (n=45; 9%), wound complications (n=29; 6%), and others (n=19; 4%). Inpatient transfers had higher rates surgical intervention (75% vs. 57%; p<0.001), although ED transfers had higher rates of urgent surgery (20% vs. 8%; p<0.001) and shorter mean time to surgery (3 vs. 5 days; p<0.001). Misdiagnosis rates were higher among ED referrals (11% vs. 4%; p=0.008). Patients undergoing elective admission (n=1,986) or admission from our own ED (n=248) had significantly shorter length of stay (p<0.001) and ICU days (p<0.001) compared to transfer patients, as well as significantly lower total cost (p<0.001).
Conclusions: In this cohort, 65% of patients required surgery, but rates were higher among inpatient referrals and misdiagnosis rates were higher among ED transfers. These data suggest that admitting non-urgent patients to local hospitals may improve diagnostic accuracy, more precisely identify patients in need of transfer, and reduce costs. Telemedicine and integration of electronic medical records may help guide referring facilities in the pursuit of additional workup and eliminate the need for unnecessary transfer and provide additional cost savings.
Patient Care: Promote safer transfer of neurosurgical patients and identify areas of cost reduction.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognize the challenges of acute neurosurgical transfer 2) Differences between transfers from inpatient units compared to emergency departments, 3) Areas for improved efficiency in care and decreased cost