J Korean Soc Emerg Med.  2006 Apr;17(2):138-145.

Appropriate Interhospital Transfer of Emergent Patients

• Ahn KO
• Hong JY
• Kim Y
• Jung KY

Abstract

BACKGROUND: Inter-hospital transfer is a risk factor of emergent patients. There should be prudentially planned interhospital transfer. The object of this study was to assess the appropriateness of inter-hospital transfer. METHOD: This study was performed prospectively from November to December 2004 in six emergency centers in two provinces. The levels of the transferring hospitals were categorized as emergency center, emergency room or nonemergency facility. Because the risks of inter-hospital transfer were higher for severely-ill patients, the patients who had been admitted to the intensive care unit and had expired in the emergency department were selected. Categories of appropriateness of inter-hospital transfer were 1) management in the transferring hospital, 2) causes of transfer, 3) management in the ambulance, and 4) violation of the law about transfer. The clauses about transfer were agreement of the receiving hospital, qualified personnel, referring sheet, and enclosure of radiology/laboratory results. We analyzed differences in the appropriateness of inter-hospital transfer between the provinces and the levels of the transferring hospitals. RESULT: A total of 1,341 patients were transferred and 148 severly-ill patients were analyzed. The rate of inappropriateness of management in the transferring hospital was 29.1%. The most common cause of transfer was the shortage of capacity at the transferring hospital (56.8%), and the lack of staff (77.4%) was the most common cause of the shortage of capacity. The rate of inappropriateness of management in the ambulance was 57.4%, and the rate of violation of the law was 79.7%. The agreement of the receiving hospital and the enclosure of radiology/laboratory results differed between the two provinces (p=0.03, p=0.01). The rate of violation of the law in emergency centers (58.3%) was lower than those in emergency room (85.0%), and non-emergency facility (88.6%) (p=0.01).
CONCLUSION
The rate of violation of the law was very high, and the safety of transferred patients was seriously threatened. Countermeasures to ensure appropriate inter-hospital transfers are needed promptly.

Keyword

Patient transfer; Risk assessment

MeSH Terms

Ambulances
Emergencies
Emergency Service, Hospital
Humans
Intensive Care Units
Jurisprudence
Patient Transfer
Prospective Studies
Risk Assessment
Risk Factors