Critical Care Transport: Outcome Evaluation After Interfacility Transfer and Hospitalization

Abstract

Study objective: To test the hypothesis that interfacility transfer is not associated with increased mortality, duration of stay, or readmission within 7 days. Methods: We matched 3,298 patients who were hospitalized for chest pain or related complaints in Kaiser Permanente medical centers after transfer from the emergency department of a nonplan hospital (transported patients) with 3,298 patients of the same gender and age (±5 years) and with the same principal diagnosis who were hospitalized within 6 months without transfer in the same Kaiser Permanente medical center (directly admitted patients). Patients were compared in terms of outcome measures: in-hospital deaths, continued care in another facility, readmission within 7 days, in-patient length of stay (LOS), and LOS in special care units. Results: The adjusted odds ratios for in-hospital mortality and readmission within 7 days were 1.0 (95% confidence interval, .8 to 1.4) and .9 (95% confidence interval, .7 to 1.2), respectively. The adjusted mean difference in LOS was –.1 days (95% confidence interval, –.2 to .1). Transported and directly admitted cardiac patients were also compared for all examined outcome measures at each of 10 medical centers. At a few medical centers, we observed significant difference in LOS, special care LOS, and continued care in another facility. However, all these differences were small, and most were probably random errors. Conclusion: Conservative patient selection criteria, pretransfer stabilization, and the use of appropriate equipment and medical personnel have resulted in the interfacility transfer program’s achieving its goal of transferring high-risk patients without adverse impact on clinical outcomes or resource use. [Selevan JS, Fields WW, Chen W, Petitti DB, Wolde-Tsadik G: Critical care transport: Outcome evaluation after interfacility transfer and hospitalization. Ann Emerg Med January 1999;33:33-43.]