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334 Interfacility Neurosurgical Transfers: An Analysis of Nontraumatic Inpatient and Emergency Department Transfers With Implications for Improvements In Care

Neurosurgery, 2018-09, Vol.65 (CN_suppl_1), p.134-134 [Peer Reviewed Journal]

Copyright © 2018 by the Congress of Neurological Surgeons 2018 ;Copyright © by the Congress of Neurological Surgeons ;Copyright © 2018 by the Congress of Neurological Surgeons ;ISSN: 0148-396X ;EISSN: 1524-4040 ;DOI: 10.1093/neuros/nyy303.334

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  • Title:
    334 Interfacility Neurosurgical Transfers: An Analysis of Nontraumatic Inpatient and Emergency Department Transfers With Implications for Improvements In Care
  • Author: Safaee, Michael ; Morshed, Ramin A ; Spatz, Jordan ; Sankaran, Sujatha ; Berger, Mitchel S ; Aghi, Manish K
  • Subjects: Cost control ; Neurosurgery ; Surgery
  • Is Part Of: Neurosurgery, 2018-09, Vol.65 (CN_suppl_1), p.134-134
  • Description: Abstract INTRODUCTION Interfacility neurosurgical transfers to tertiary care centers are driven by a number of variables including lack of onsite 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 Nontraumatic adult neurosurgical transfers to a single tertiary care center were analyzed over 12 mo. RESULTS A total of 504 transfer patients were accepted with a mean age 55 yr (range: 19-92) and 53% women. Points of origin were ED in 54% and inpatient hospital unit in 46% with mean distance traveled of 119 miles. Broad diagnosis categories included brain tumors (n = 142; 28%), vascular lesions or intracerebral hemorrhage (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 < .001), although ED transfers had higher rates of urgent surgery (20% vs 8%; P < .001) and shorter mean time to surgery (3 vs 5 d; P < .001). Misdiagnosis rates were higher among ED referrals (11% vs 4%; P = .008). Patients undergoing elective admission (n = 1986) or admission from our own ED (n = 248) had significantly shorter length of stay (P < .001) and ICU days (P < .001) compared to transfer patients, as well as significantly lower total cost (P < .001). CONCLUSION 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 nonurgent 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.
  • Publisher: Oxford: Oxford University Press
  • Language: English
  • Identifier: ISSN: 0148-396X
    EISSN: 1524-4040
    DOI: 10.1093/neuros/nyy303.334
  • Source: ProQuest Central
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