Comparison of Inter-hospital Urological Transfers Between a Metropolitan and Rural Tertiary Care Institution

Abstract

IntroductionUrological services are not available at all hospitals, and the transfer of patients between medical centers provides an avenue to meet medical need. In rural areas, patients often visit community medical centers with limited services and require transfer. We aimed to compare the transfer process between two tertiary care institutions, one serving a metropolitan and the other a rural population. MethodsTwo academic medical centers were selected, one which primarily services a large metropolitan city center, while the second primarily services a large rural population. Transfer logs for the urological services from September 2015 to September 2017 were compared. Records were examined for an affiliated urologist at the originating hospital, distance traveled, reason for transfer, and the need for surgical management. Variables were analyzed using descriptive statistics. ResultsOverall, 606 transfers were included, with 16% (97/606) transferred to the metropolitan center and 84% (509/606) to the rural center. Patients transferred to the rural center were younger (53.3 versus 61.9; p<0.001) and traveled further (64.2 versus 36.5 miles; p<0.001) compared to the metropolitan site. Hospitals referring patients to the rural center were less likely to have an affiliated urologist (66.7% versus 91.1%; p=0.008). 38% of patients were surgically managed which was not different between the institutions. ConclusionsDifferences exist between transfers to the rural and metropolitan center, suggesting an increased need for basic urological services in the surrounding rural community. At both centers, most patients did not require a procedure and might avoid transfer through telehealth or collaborative care networks.