Abstract
Emergency department (ED) crowding is a universal issue. In Taiwan, patients with common medical problems prefer to visit ED of medical centers, resulting in overcrowding. Thus, a bed-to-bed transfer program has been implemented since 2014. However, there was few studies that compared clinical outcomes among patients who choose to stay in medical centers to those being transferred to regional hospitals. The aim of this study was to explore the transfer rate, delineate the factors related to patient transfer, and clarify the influence upon the program outcomes. A retrospective cohort study was conducted using demographic and clinical disease factors from the patient electronic referral system, electronic medical records (EMRs) of a medical center in Taipei, and response to referrals from regional hospitals. The study included adult patients who were assessed as appropriate for transfer in 2016. We analyzed the outcomes (length of stay and mortality rate) between the referrals were accepted and refused using propensity score matching. Of the 1759 patients eligible for transfer to regional hospitals, 420 patients (24%) accepted the referral. Medical records were obtained from the regional hospitals for 283 patients (67%). After propensity score matching, the results showed that interhospital transfer resulted in similar median total length of stay (8.7 days in the medical center vs 7.9 days in regional hospitals; P=.245). In-hospital mortality was low for both groups (3.1% in the medical center vs 1.3% in regional hospitals; P=.344). Transfer from an overcrowded ED in a medical center to regional hospitals in eligible patients results in non-significant outcome of total length of stay. With the caveat of an underpowered sample, we did not find statistically significant differences in in-hospital mortality. This healthcare delivery model may be used in other cities facing similar problems of ED overcrowding.
Highlights
Emergency department (ED) crowding is a universal and important issue in the world because it has a great effect on patient safety and contributes to worse patient outcomes.[1]
Exclusion criteria were patients younger than 20 years of age, those transferred to a nonregional hospital, those with psychosis as a major diagnosis, and those transferred for surgery or hospice care
We examined a total of 1759 patients who were eligible for transfer from the medical center to regional hospitals
Summary
Taiwan’s implementation of National Health Insurance starting in 1995 has changed patients’ medical utilization habits.[11] Patients nowadays prefer to visit EDs in medical centers than to visit regional hospitals for trivial problems with lower severity levels. The purpose of the bedto-bed transfer program is to transfer patients who needed hospitalization directly to regional hospital wards from the ED of medical centers in order to mitigate ED crowding, to increase emergency capacity, and to decrease time spent in the ED. Patients can receive appropriate medical resources and care, and hopefully have a better outcome
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