Transfer Requests Research Articles

Improving Patient Transfer Quality: A Retrospective Study on a Transfer Center for a Canadian Upper Extremity Revascularization Program

Background: Centralization to trauma centers is the gold standard for digital revascularization, but avoidable transfers constitute a real challenge to the trauma network. Our transfer center is characterized by a 24/7 call center managed by specialized nurses responsible for data collection, pictures and imagery transmissions and arrangement of systematic recorded discussions between referring doctors and surgeons. This study investigated the impact of implementing a dedicated transfer center on avoidable patient transfers to a centralized quaternary care center for upper extremity injuries requiring revascularization. Methods: A retrospective study was performed from September 2017 to December 2021. We included all transfer requests from outside facilities to revascularize upper extremity injuries. Transfers were considered avoidable if no exploration or microsurgical vascular procedure was attempted. Univariate and multivariate analysis were employed to compare transfer outcomes before and after the addition of the transfer center in 2019. Results: 795 transfer requests were analyzed, of which 326 occurred before the implementation of the transfer center and 469 occurred after. Following this addition, the incidence of transfer requests increased from 13.48 requests per month to 16.96 (p=0.016). It improved communications between referring doctors and surgeons and improved triage selection, resulting in an increase of transfer refusals (from 47% to 56%, p=0.009). Avoidable transfers significantly decreased by 7.32% (p=0.047) following the implementation of the standardized protocol and call center. Conclusions: Unnecessary interhospital transfers in the context of digital revascularization burden the trauma network. Introducing a dedicated transfer center reduces avoidable transfers by improving triage selection and communications.

Appropriately Matching Transport Care Units to Patients in Interhospital Transport Care: Implementation Study.

In interfacility transport care, a critical challenge exists in accurately matching ambulance response levels to patients' needs, often hindered by limited access to essential patient data at the time of transport requests. Existing systems cannot integrate patient data from sending hospitals' electronic health records (EHRs) into the transfer request process, primarily due to privacy concerns, interoperability challenges, and the sensitive nature of EHR data. We introduce a distributed digital health platform, Interfacility Transport Care (ITC)-InfoChain, designed to solve this problem without compromising EHR security or data privacy. This study aimed to detail the implementation of ITC-InfoChain, a secure, blockchain-based platform designed to enhance real-time data sharing without compromising data privacy or EHR security. The ITC-InfoChain platform prototype was implemented on Amazon Web Services cloud infrastructure, using Hyperledger Fabric as a permissioned blockchain. Key elements included participant registration, identity management, and patient data collection isolated from the sending hospital's EHR system. The client program submits encrypted patient data to a distributed ledger, accessible to the receiving facility's critical care unit at the time of transport request and emergency medical services (EMS) teams during transport through the PatienTrack web app. Performance was evaluated through key performance indicators such as data transaction times and scalability across transaction loads. The ITC-InfoChain demonstrated strong performance and scalability. Data transaction times averaged 3.1 seconds for smaller volumes (1-20 transactions) and 6.4 seconds for 100 transactions. Optimized configurations improved processing times to 1.8-1.9 seconds for 400 transactions. These results confirm the platform's capacity to handle high transaction volumes, supporting timely, real-time data access for decision-making during transport requests and patient transfers. The ITC-InfoChain platform addresses the challenge of matching appropriate transport units to patient needs by ensuring data privacy, integrity, and real-time data sharing, enhancing the coordination of patient care. The platform's success suggests potential for regional pilots and broader adoption in secure health care systems. Stakeholder resistance due to blockchain unfamiliarity and data privacy concerns remains. Funding has been sought to support a pilot program to address these challenges through targeted education and engagement.

Implementation of Direct Admission to the Operating Room Procedure for Children Transported With Airway Emergencies

ObjectiveChildren with airway emergencies, such as aspirated foreign bodies (FBs), who present to community emergency departments usually require expeditious transfer to centers with pediatric expertise. In 2018, our hospital's transport team implemented a multidisciplinary direct admission to the operating room (OR) protocol for children transferred for emergent surgical intervention, which bypassed typical hospital entry points. We aimed to assess its impact on time to definitive care and patient outcomes. MethodsWe performed a retrospective chart review of all patients aged ≤18 years with suspected aspirated FB transferred to our institution for emergent surgical intervention between July 1, 2013 and March 1, 2023. We determined whether they were taken to the OR post-transfer after first being evaluated in our pediatric emergency department/intensive care unit (Standard protocol) or transported directly to the OR by the transport team (OR Transport protocol). Demographics, transport/surgical times, and clinical data were compared between the groups using t-test and Mann-Whitney U test. ResultsOf the 27 children who met the inclusion criteria, 14 (51.9%) were transported via the Standard protocol and 13 (48.1%) via the OR Transport protocol. Demographics, referring hospital characteristics, time of transfer request, need for mechanical ventilation pretransport, and transport mode were not different; rates of critical care transports were higher for the OR Transport group than for the Standard group (P = .016). Compared with the Standard group, the OR Transport group had shorter median (interquartile range) times from transport arrival to start of surgery (8 [0-15.5] vs. 94.5 [25.75-148.75] minutes, P < .001) and from transport dispatch to surgery (103 [64.25-144] vs. 179 [115.5-265] minutes, P = .035). Although not statistically significant, the OR Transport group had a lower hospitalization rate after the surgery compared with the Standard group (38.5% vs. 64.3%). ConclusionImplementation of a direct admission to the OR protocol seems to expedite definitive treatment and may be associated with a decreased need for hospitalization for children with airway FBs who require interhospital transport for emergent surgical intervention.

Tax Dispute Analysis of Incorrect Vat Payment on Offshore Royalty Viewed From the Ease of Administration Principle (Case Study of PT X)

The purposes of this research are: (i) to analyse basic considerations from the Indonesian Tax Authority (ITA) in making regulations regarding the incorrect transfer of VAT on taxable services from outside customs territory which cannot be overbooked; and (ii) to analyse whether the administrative sanctions penalized to the taxpayer are appropriate from the ease of tax administration principle’s perspective. This study is using (i) VAT imposition on intangible taxable goods and services from outside the Indonesian customs territory; (ii) Ease of Administrative principles: certainty, efficiency, convenience of payment, and simplicity as theoretical references. The research is categorized as applied study with a qualitative method using qualitative data collection techniques through literatures and field studies (interview with various key informants from ITA, representatives of the taxpayers, and taxation experts and academia. The qualitative analysis on data/information was done via triangulating process with related theories, VAT laws and regulation, as well as expert opinions. Results of the study conclude that the basis of considerations of the ITA makes regulations for the utilization of Intangible Taxable Goods and Taxable Services from Outside the Customs Territory, which cannot be done with overbook because both offshore VAT objects are difficult to detect and can be used for tax avoidance modus by the taxpayers. The ownership of documentary evidence is actually a foreign party while the person who is supposed to make a transfer request is the owner of the document evidence, and the tax that has been deposited has become a tax credit and will not move to another place other than the state treasury because the tax credit is the taxpayer's right. Considerations taken by ITA have not met the theory of good tax administration because there has been no legal formulation related to this matter and ITA's accountability is still considered to be lacking in terms of supervision and control. Administrative sanctions penalized to PT X due to tax deposit errors are not in accordance with the ease of tax administration principle. Even though it is certainly stipulated in the prevailing law and regulation, but the procedure is so lengthy and detrimental to the taxpayer, increase and disrupt cash flow for business activities carried out by PT X. In terms of efficiency principle, the rejection of overbooking process creates additional compliance costs to the taxpayer, namely: fiscal financial cost, time cost and psychological cost and denial the facts that actually the fund/money have been transferred to the State Treasury. Implications of research: To provide examples of practice in the field of how complicated tax administration procedures can cause unnecessary losses for taxpayers if the tax regulations are not made by taking into account the principle of ease of tax administration. It is also recommended that the tax authorities should reduce administrative burden for the implementation of rights and fulfillment of tax obligations that are too rigid to be more friendly in order to make it easier for taxpayers to carry out their tax obligations and make themselves a facilitator for taxpayers to increase cooperative tax compliance. Originality/value: Ease of carrying out tax obligations for taxpayers must be something that is facilitated by the Tax Authority rather than being subject to penalties and this can be done, one way, through the application of the principle of ease tax administration in the formulation of tax regulations.

Impact of the Southeast Melbourne Virtual Emergency Department on reducing transfers from residential aged care facilities.

To evaluate the impact of the Southeast Melbourne Virtual Emergency Department (SEMVED) on transfers from residential aged care facilities (RACFs) to traditional EDs. A cohort study of residents requesting transfer to the ED via ambulance within participating health networks' catchments from April to June 2022. Two hundred thirty-eight VED consultations occurred with 79% (188/238) avoiding transfer. This represented an avoidance of 12% (188/1511) of all requests for transfer during operating hours. SEMVED prevented unnecessary transfers and enabled in-facility care. Integration into community outreach programmes could enhance care delivery. Patient safety outcomes were not formally assessed by our methodology.

Relation between the time of the transport team in reaching the bedside of children and the 30-day mortality rate after admission.

China's medical system has not yet issued quality control indicators related to the transfer of critically ill children, and when transport teams receive a transfer request for these children, due to various reasons, the time to arrive at the bedside varies. The aim of this study was to investigate the effect of the time taken by the pediatric intensive care transport team to reach the bedside of children after receiving a transport request on the prognosis of these children. Clinical data of 298 critically ill children admitted to Anhui Children's Hospital through long-distance transport from March 2020 to February 2022 were retrospectively analyzed. Pediatric patients were divided into three groups according to the time taken by the transport team to reach the bedside after receipt of a transport request: the ≤60, >60 to ≤180, and >180 min groups. The 30-day mortality of children after admission (0= no, 1= yes) was used as the dependent variable for multivariate logistic regression analysis, with the odds ratio (OR) and 95% confidence interval (CI) indicating the relation between the time taken by the transport team to reach the bedside and the 30-day mortality rate after admission. P<0.05 indicated a statistically significant difference. During the study period, there were 298 children for whom transports were requested, 50 (16.8%) of whom died within 30 days after admission. The limited evidence revealed that the time taken by the transport team to reach the bedside of children was not significantly related to the 30-day mortality rate after admission in Anhui Children's Hospital (P>0.05). The time taken by the transport team to reach the bedside of children is not associated with the 30-day mortality rate after admission into the pediatric intensive care unit (PICU).

Transfer of embryos with positive PGT-M results: Genetic Counselors' perspectives and ethical considerations.

Increasing numbers of fertility patients use preimplantation genetic testing for monogenic conditions (PGT-M) during invitro fertilization (IVF). While PGT-M is primarily used to avoid implanting embryos with a monogenic condition, patients can request to transfer an embryo with the monogenic condition (positive embryo transfer), especially in cases where an IVF cycle results in no unaffected embryos. Transferring embryos with known disease-causing variants raises ethical concerns. There is limited understanding about how stakeholders in the assisted reproductive technology (ART) field approach these issues. In this study, genetic counselors were sent a survey to gather insight into their views about transferring embryos with different monogenic conditions. N = 99 genetic counselors completed the survey, 22 of whom had experience with patients requesting or deciding to transfer an embryo with a monogenic condition (positive embryo transfer experience). Most participants, including those with positive embryo transfer experience, were supportive of positive embryo transfer, regardless of the genetic condition. While participating genetic counselors were largely supportive of all patient decisions, they reported increased moral uneasiness around transferring embryos with life-limiting monogenic conditions, such as Huntington's disease. Further investigation into the experiences of genetic counselors who have experienced positive embryo transfer requests in practice can help delineate the ethical questions that ART providers face in this context and clarify how genetic counselors can contribute to establishing guidelines in the ART field.

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany.

Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.

A review of electrochemical cells and liquid metal battery (LMB) parameter development

Liquid Metal Battery (LMB) technology is a new research area born from a different economic and political climate that has the ability to address the deficiencies of a society where electrical energy storage alternative are lacking. The United States government has begun to fund scholarly research work at its top industrial and national laboratories. This was to develop liquid metal battery cells for energy storage solutions. This research was encouraged during the Cold War battle for scientific superiority. Intensive research then drifted towards high energy rechargeable batteries, which work better for automobiles and other applications. Intensive research has been carried out on the development of electrochemical rechargeable all-liquid energy storage batteries. The recent request for green energy transfer and storage for various applications, ranging from small-scale to large-scale power storage, has increased energy storage advancements and explorations. The criteria of high energy density, low cost, and extensive energy storage provision have been met through lithium-ion batteries, sodium-ion batteries, and Liquid Metal Battery development. The objective of this research is to establish that liquid metal battery technology could provide research concepts that give projections of the probable electrode metals that could be harnessed for LMB development. Thus, at the end of this research, it was discovered that the parameter estimation of the Li//Cd-Sb combination is most viable for LMB production when compared with Li//Cd-Bi, Li-Bi, and Li-Cd constituents. This unique constituent of the LMB parameter estimation would yield a better outcome for LMB development.

Implementation of an Interdisciplinary Transfer Huddle Intervention for Prolonged Wait Times During Inter-ICU Transfer

ICU transfers from a regional to a tertiary-level hospital are initiated typically for a higher level of care. Extended transfer wait times can negatively affect survival, length of stay (LOS), and cost. In this prospective single-center study, the subjects were adult ICU patients admitted to regional hospitals between January and October 2022, for whom a request was made to transfer to a tertiary-level medical ICU. The authors developed and implemented an interdisciplinary transfer huddle intervention (THI) with the goal of reducing wait times by providing a consistent channel of communication between key stakeholders. The primary outcome was the number of hours elapsed between transfer request and the time of transfer to the tertiary hospital. Secondary outcomes included in-hospital mortality, discharge to home, ICU LOS, and hospital LOS. Data were abstracted from electronic health records and periods before (January to June 2022) and after (June to October 2022) the intervention were compared. Data were analyzed using logistic regression or negative binomial regression, adjusting for patient demographic and clinical characteristics. ICU fellows also completed a daily survey about barriers they perceived to the THI application. During the study period, 76 patients were transferred. The THI was completed 75.0% of the time. There were no statistically significant differences in the primary and secondary outcomes before and after the intervention. The top perceived barriers to transfer were lack of physical beds (50.0%) and staffing limitations (37.5%). The authors successfully developed and implemented a transfer huddle to ensure consistent interdisciplinary communication for patients being transferred between ICUs and identified barriers to such transfer. However, transfer times and patient outcomes were not significantly different after the change. Future studies should consider staffing challenges, hospital capacity, and the role of dedicated transfer teams in in decreasing inter-ICU transfer wait times.

Fluency is the Key: AI Agent Language Dynamics on Customer Satisfaction and Transfer Requests

Fluency is the Key: AI Agent Language Dynamics on Customer Satisfaction and Transfer Requests

FTS Service Evolution and LHC Run-3 Operations

The File Transfer Service (FTS) is a software system responsible for queuing, scheduling, dispatching and retrying file transfer requests, it is used by three of the LHC experiments, namely ATLAS, CMS and LHCb, as well as non LHC experiments including AMS, Dune and NA62. FTS is critical to the success of many experiments and the service must remain available and performant during the entire LHC Run-3. Experiments use FTS to manage the transfer of their physics files all over the World or more specifically all over the Worldwide LHC Computing Grid (WLCG). Since the start of LHC Run-3 (from 5th July 2022 to 31st August 2023), FTS has managed the successful transfer of approximately 1.2 billion files totalling 1.83 Exabytes of data.This paper describes how the FTS team has evolved the software and the deployment in order to cope with changes in implementation technologies, increase the efficiency of service, streamline its operations, and to meet the ever changing needs of its user community. We report about the software migration from Python 2 to Python 3, the move from the Pylons web development framework towards Flask and the new database deployment strategy to separate the handling of the critical operations from the long duration monitoring queries. In addition, during 2022 a new HTTP based protocol has been finalised that can now be used between FTS and compatible WLCG tape storage endpoints.

Development of the method of special ship ice observations

Since the middle of the XXth century researchers at the Arctic and Antarctic Research Institute (AARI) have been carrying out special ship ice observations in the Arctic and other freezing seas. Field data about main sea ice parameters are necessary for developing and validation of sea ice forecasts and satellite information. In keeping with technological advances and new research and practical tasks this method is ever developing. In spring 2023 sea ice observations were organized by the AARI’s reseachers onboard the nuclear icebreaker 50 let Pobedy in the south-western part of the Kara Sea. This paper presents recommendations concerning the method of special ship ice observations as developed during the expedition: dispatch to the vessel of operative and forecast hydrometeorological information from the AARI with a request for return transfer to the AARI of the processing results of the data obtained in the areas of predicted high deformation of ice cover along the route of navigation and upgrade of the ship television complex to receive information about ice layers and structure.

Debate 3: Genetically Tested Embryos Expected to Have Mild Adult Disease Should Not Be Transferred

MOTION: For Next generation sequencing (NGS) technology has been widely used in the field of genetic diseases, mainly focusing on the diagnosis of genetic diseases, newborn screening, prenatal screening, preimplantation genetic test (PGT) and other fields such as the treatment of cancer. In the field of reproductive medicine, there are still some issues that engendered controversy about the application of PGT. On one hand, disputes over whether using PGT to treat late-onset diseases is ethical remain. On the other hand, some tested embryos are “available” to transfer, while others are “discarded” embryos that are “unavailable” because they are detected carrying certain genetic flaws. But there are still some embryos biopsied expected to have some genetic abnormality that might or not cause malfunction, including embryos with copy number variant of uncertain significance (VUS), embryos tested with adult-onset genetically anomalousness, embryos of balanced translocation as well as mosaic embryos. So how to dispose of this group of embryos in clinical practice is a hot issue up to now. In this debate, we reviewed the relevant case reports and original research combined with the joint consensus or committee opinion to state our proposition: embryos tested with possible abnormal genetic characteristics and thus expected to have mild adult disease should not be transferred. Parents undergoing PGT may wish to avoid the lifelong concern caused by the chance that their children may develop adult-onset conditions. The transfer of embryos expected to have mild adult disease is contrary to their original intention of seeking PGT treatment. Whether intentional or incidental, the discovery and request for transfer of embryos likely to result in the birth of offspring with health-affecting conditions pose ethical dilemmas for physicians and their staff, patients, and society. MOTION: AGAINST Preimplantation genetic testing provides couples with powerful reproductive choices. The technology allows individuals to avoid giving birth to children with significant health issues and developmental disability. Additionally, serious familial adult-onset conditions, such as predisposition to cancer or dementia, can be screened out of future generations. Polygenetic risk scores will be the next leap in genetic testing technology. This data can used to determine the chances of an embryo developing adult-onset conditions such as cardiovascular disease, diabetes, mental illness and even gout. This presentation argues that there is a limit at which society should stop screening embryos for disease and draws upon practical observations and well-accepted ethical frameworks to support the case.

Time to Transfer as a Quality Improvement Imperative: Implications of a Hub-and-Spoke Health System Model on the Timing of Emergency Procedures.

In the increasingly prevalent hub-and-spoke health system model, specialized services are centralized at a hub hospital, while spoke hospitals offer more limited services and transfer patients to the hub as needed. In one urban, academic health system, a community hospital without procedural capabilities was recently incorporated as a spoke. The goal of this study was to assess the timeliness of emergent procedures for patients presenting to the spoke hospital under this model. The authors performed a retrospective cohort study of patients transferred from the spoke hospital to the hub hospital for emergency procedures after the health system restructuring (April 2021-October 2022). The primary outcome was the proportion of patients who arrived within their goal transfer time. Secondary outcomes were time from transfer request to procedure start and whether procedure start occurred within guideline-recommended treatment time frames for ST-elevation myocardial infarction (STEMI), necrotizing soft tissue infection (NSTI), and acute limb ischemia (ALI). A total of 335 patients were transferred for emergency procedural intervention during the study period, most commonly for interventional cardiology (23.9%), endoscopy or colonoscopy (11.0%), or bone or soft tissue debridement (10.7%). Overall, 65.7% of patients were transferred within the goal time. 23.5% of patients with STEMI met goal door-to-balloon time, and more patients with NSTI (55.6%) and ALI (100%) underwent intervention within the guideline-recommended time frame. A hub-and-spoke health system model can provide access to specialized procedures in a high-volume, resource-rich setting. However, ongoing performance improvement is required to ensure that patients with emergency conditions receive timely intervention.

Characteristics and Effectiveness of Mobile- and Web-Based Tele-Emergency Consultation System between Rural and Urban Hospitals in South Korea: A National-Wide Observation Study.

(1) Background: The government of South Korea has established a nationwide web- and mobile-based emergency teleconsultation network by designating urban and rural hospitals. The purpose of this study is to analyze the characteristics and effectiveness of the tele-emergency system in South Korea. (2) Methods: Tele-emergency consultation cases from May 2015 to December 2018 were analyzed in the present study. The definition of a tele-emergency in the present study is an emergency consultation between doctors in rural and urban hospitals via a web- and mobile-based remote emergency consultation system (RECS). Consultations through an RECS are grouped into three categories: medical procedure or treatment guidance, image interpretation, and transportation requests. The present study analyzed the characteristics of the tele-emergency system and the reduction in unnecessary transportation (RUT). (3) Results: A total of 2604 cases were analyzed in the present study from 2985 tele-emergency consultation cases. A total of 381 cases were excluded for missing data. Consultations for image interpretation were the most common in trauma cases (71.3%), while transfer requests were the most common in non-trauma cases (50.3%). Trauma patients were more frequently admitted to rural hospitals or discharged and followed up with at rural hospitals (20.3% vs. 40.5%) after consultations. In terms of disease severity, non-severe cases were statistically higher in trauma cases (80.6% vs. 59.4%; p < 0.001). The RUT was statistically highly associated with trauma cases (60.8% vs. 42.8%; p < 0.001). In an analysis that categorized cases by region, a statistically higher proportion of transportation was used in island regions (69.9% vs. 49.5%; p < 0.003). More RUT was associated with non-island regions (30.1% vs. 50.5%; p = 0.001). (4) Conclusions: The tele-emergency system had a great role in reducing unnecessary patient transportation in non-severe trauma cases and non-island rural area emergency cases. Further research is needed for a cost/benefit analysis and clinical outcomes.

Service Recovery via Twitter: An Exploration of Responses to Consumer Complaints*

AbstractThe online response to customer complaints (i.e., service recovery) is a central feature of modern organizations' customer‐focused performance management systems. Motivated by the lack of descriptive information related to complaint handling that can be used in assessing managerial performance, we collect organizations' responses to consumer complaints via Twitter and apply Zemke and Schaaf's (1990) traditional service recovery model to explore these. We collected 10,305 tweets that describe the use of Twitter for service recovery by organizations across four industries: airlines, casual dining chain restaurants, hotels, and fast‐food restaurants. The findings show that in our sample, the traditional service recovery model with five service recovery elements (apology, urgent reinstatement, empathy, symbolic atonement, and follow‐up) is implemented to various degrees. Furthermore, we identify three additional service recovery elements not previously discussed by prior research: channel transfer, feedback acknowledgment, and information request. Our findings have research implications and highlight the importance of incorporating online customer complaints into managerial performance systems.

Examining Predictors of Early Admission and Transfer to the Critical Care Resuscitation Unit.

Previous studies have demonstrated that rapid transfer to definitive care improves the outcomes for many time-sensitive conditions. The critical care resuscitation unit (CCRU) improves the operations of the University of Maryland Medical Center (UMMC) by expediting the transfers and resuscitations for critically ill patients who exceed the resources at other facilities. In this study we investigated CCRU transfer patterns to determine patient characteristics and logistical factors that influence bed assignments and transfer to the CCRU. We hypothesized that CCRU physicians prioritize transfer for critically ill patients. Therefore, those patients would be transferred faster. We performed a retrospective review of all non-traumatic adult patients transferred to the CCRU from other hospitals between January 1-December 31, 2018. The primary outcome was the interval from transfer request to CCRU bed assignment. The secondary outcome was the interval from transfer request to CCRU arrival. We used multivariate logistic regressions to determine associations with the outcomes of interest. A total of 1,741 patients were admitted to the CCRU during the 2018 calendar year. Of those patients, 1,422 were transferred from other facilities and were included in the final analysis. Patients' mean age was 57 ± 17 years with a median Sequential Organ Failure Assessment (SOFA) score of 3 [interquartile range 1-6]. Median time from transfer request to CCRU bed assignment was 8 (0-70) minutes. A total of 776 (55%) patients underwent surgical intervention after arrival. Using the median transfer request to bed assignment time, we found that patients requiring stroke neurology (odds ratio [OR] 5.49, 95% confidence interval [CI] 2.85-10.86), having higher SOFA score (OR 1.04, 95% CI 1.001-1.07), and needing an immediate operation (OR 2.85, 95% CI 1.98-4.13) were associated with immediate bed assignment time (≤8 minutes). Patients who were operated on (OR 0.74, 95% CI 0.55-0.99) were significantly less likely to have an immediate bed assignment time. The CCRU expedited the transfer of critically ill patients who needed urgent interventions from outside facilities. Higher SOFA scores and the need for urgent neurological or surgical intervention were associated with near-immediate CCRU bed assignment. Other institutions with similar models to the CCRU should perform studies to confirm our observations.

Trends in patients' behavior for cancer care and the number of registered cancer cases in Ehime Prefecture during the coronavirus disease pandemic.

The coronavirus disease (COVID-19) pandemic has reduced diagnosed cancer cases worldwide. This study aimed to elucidate the recovery of cancer care from the COVID-19 pandemic in Ehime Prefecture, Japan. This study collected data from the hospital-based cancer registry (HBCR) as well as the number of outpatients, medical information provision fee payments (MIP2) and second opinion patients (SOP) from the Council of Ehime Cancer Care Hospitals (ECCH). Then cancer care and patient requests for hospital transfers before and during the COVID-19 pandemic were analysed. The HBCR from the ECCH comprises >80% of cancer cases in Ehime Prefecture. In 2020, the numbers of all registered cases, first-line treatment cases and cases detected by cancer screening in the HBCR decreased from those in 2018-2019. In 2021, they increased to almost the same levels as those in 2020. In contrast, the number of registered patients that changed hospitals (hospital-change cases) after first-line treatments, patients who lived outside the metropolitan area of Ehime but registered in metropolitan hospitals, MIP2 and SOP remained low in 2021 after decreasing in 2020. Furthermore, the monthly numbers of hospital-change cases, MIP2 and SOP were significantly smaller in 2021 than in 2018-2019 (Wilcoxon rank sum test). The assessed indicators suggest that the decreased patients' behavior to further cancer care had not returned to pre-pandemic levels by 2021. Hence, psychological measures in society to prevent self-restraint in patients and support for the caregivers of the patients who have some problems visiting the hospital are necessary.

Evaluating the predictive ability of natural language processing in identifying tertiary/quaternary cases in prioritization workflows for interhospital transfer.

Tertiary and quaternary (TQ) care refers to complex cases requiring highly specialized health services. Our study aimed to compare the ability of a natural language processing (NLP) model to an existing human workflow in predictively identifying TQ cases for transfer requests to an academic health center. Data on interhospital transfers were queried from the electronic health record for the 6-month period from July 1, 2020 to December 31, 2020. The NLP model was allowed to generate predictions on the same cases as the human predictive workflow during the study period. These predictions were then retrospectively compared to the true TQ outcomes. There were 1895 transfer cases labeled by both the human predictive workflow and the NLP model, all of which had retrospective confirmation of the true TQ label. The NLP model receiver operating characteristic curve had an area under the curve of 0.91. Using a model probability threshold of ≥0.3 to be considered TQ positive, accuracy was 81.5% for the NLP model versus 80.3% for the human predictions (P = .198) while sensitivity was 83.6% versus 67.7% (P<.001). The NLP model was as accurate as the human workflow but significantly more sensitive. This translated to 15.9% more TQ cases identified by the NLP model. Integrating an NLP model into existing workflows as automated decision support could translate to more TQ cases identified at the onset of the transfer process.