Impact of Interfacility Patient Transport for Appendectomy on Patient Outcomes

Abstract

<h3>Introduction</h3> Patients presenting to emergency departments with complaints requiring emergency general surgery (EGS) often require transport to tertiary care because fewer than 50% of hospitals have EGS services. The need for interfacility transport to tertiary care is associated with increased hospital length of stay (LOS) and morbidity among medical patients, however there is limited data available evaluating the cost and impact of transports among EGS patients. The purpose of this study was to analyze the costs, transport resource utilization, and outcomes of EGS patients transferred to tertiary care with acute appendicitis. <h3>Methods</h3> This was an IRB approved retrospective study of adult patients transferred from an in-network referral ED to a single tertiary care facility between 20 May 2015 & 30 September 2020 who were transferred with diagnosis of appendicitis. Data collected from the health system's electronic medical record (EMR) included patient demographics, emergency department and interfacility transport hemodynamics, diagnostic testing results, timeliness of referral and transport, transport level of care, social determinants of health, and patient charges. Data was analyzed with R version 1.0.2. Our Primary Outcome was the hospital length of stay and our secondary outcomes were time from initial presentation to incision, cost to patient, and transport resource allocation. <h3>Results</h3> A total of 480 adult patients were transferred for tertiary EGS care during the study period and were included in the final analysis. 89.4% of patients (n=429) received ambulance transport awhile 10.6% (n=51) were transported via private vehicle. All patients were discharged home alive. Critical Care Transport (CCT) teams transported 61.5% (n=295) of patients while Advanced Life Support (ALS) teams transported 26.0% (n=125). Although CCT teams were more likely than ALS teams to establish and maintain intravenous fluids (54.6% vs 37.6%, p=0.002) there was no difference in analgesia (36.9% vs 27.4% p=0.078), antiemetic (26.8% vs 20.0% p=0.178), or antibiotic (13.3% vs 6.4% p=0.062) administration between critical care and ALS providers. No life-saving interventions were provided by any transport team. Ambulance transport did not shorten hospital length of stay compared to transport via private vehicle (p=0.67). <h3>Conclusion</h3> In this single center study transport via ambulance did not reduce hospital length of stay compared to transport via private vehicle and there was no difference in the care provided between ALS and CCT teams.