Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T12:50:40.100Z Has data issue: false hasContentIssue false
  • English
  • Français

Capacity-related interfacility patient transports: patients affected, wait times involved and associated morbidity

Published online by Cambridge University Press:  21 May 2015

Esther Stolte ,
Rod Iwanow  and
Christine Hall
Esther Stolte
Affiliation:
Family Medicine Resident, Queen's University, Kingston, Ont.
Rod Iwanow
Affiliation:
Department of Emergency Medicine, Calgary Health Region, Calgary, Alta.
Christine Hall*
Affiliation:
Department of Emergency Medicine, Calgary Health Region, Calgary, Alta.
*
Department of Emergency Medicine, Room C231, Foothills Hospital, 1403 29 St. NW, Calgary AB T2N 2T9

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

The trend toward operating Canadian hospitals at full capacity necessitates in some settings the transfer of patients from one hospital's emergency department (ED) to another hospital for admission, due to lack of bed availability at the first hospital. Our objectives were to determine how many and which patients are transported, to measure how much time is spent in the peri-transport process and to document any morbidity or mortality associated with these periods of transitional care.

Methods:

In this retrospective, observational health records review, we obtained health records during February, June and October 2002 for patients evaluated in any 1 of 3 adult EDs from a single Canadian city and subsequently transferred for admission to 1 of the other 2 hospitals. Data included the reason for transport, admitting service, transport process times and administration of key medications (asthma, cardiac, diabetes, analgesic or antibiotics).

Results:

Five hundred and thirteen records of transported patients were reviewed, and 507 were evaluated. Of those, 372 (73.4%) transfers were capacity-related and 135 (26.6%) were transferred for specialty services. Of the capacity transports, 219 (58.9%) were admissions for psychiatry and 123 (33.1%) for medicine. Median wait time at the first hospital was 6.7 hours, being longest for psychiatric patients. Thirty patients (8.1%) missed 1 or more doses of a key medication in the peri-transport process, and 8 (2.2%) missed 2 or more.

Conclusions:

Overcrowding of hospitals is a significant problem in many Canadian EDs, resulting in measurable increases in lengths of stay. Transfers arranged to other facilities for admission further prolong lengths of stay. Increased boarding times can result in missed medications, which may increase patient morbidity. Further study is needed to assess the need for capacity transfers and the possible risk to patients associated with periods of transitional care.

Keywords

interfacility transfercapacity
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 4 , July 2006 , pp. 262 - 268
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

References

1.Canadian Association of Emergency Physicians. Presentation to the Commission of the Future Health Care in Canada (Romanow Commission). Calgary: 2002. Available: www.caep.ca/002.policies/002-04.romanow/002-04.Romanow-Taylor.Apr2002.pdf (accessed 2006 May 24).Google Scholar
2.Koppenberg, J, Taeger, K. Interhospital transport: transport of critically ill patients. Curr Opin Anaesthsiol 2002;15:211–5.Google Scholar
3.Gordon, F. Shift work for specialist registrars in acute medicine: more questions than solutions. Clin Med 2002;2:41–2.CrossRefGoogle ScholarPubMed
4.Nathens, AB, Maier, RV, Brundage, SI, et al., The effect of inter-facility transfer on outcome in an urban trauma system. J Trauma 2003;55(3):444–9.Google Scholar
5.Sobie, JM, Gaves, D, Tringali, A. ED “hold” patients: Is their care also being held? J Emerg Nurs 2000;26:549–53.CrossRefGoogle ScholarPubMed
6.Andrulis, DP, Kellermann, A, Hintz, EA, et al. Emergency departments and crowding in United States teaching hospitals. Ann Emerg Med 1991;20:980–6.CrossRefGoogle ScholarPubMed
7.Meehan, TP, Fine, MJ, Krumholz, HM, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 1997;278:2080–4.Google Scholar
8.McGarvey, RN, Harper, JJ. Pneumonia mortality reduction and quality improvement in a community hospital. QRB Qual Rev Bull 1993;19:124–30.Google Scholar
9.Walker, AF. The legal duty of physicians and hospitals to provide emergency care [review]. CMAJ 2002;166:465–9.Google ScholarPubMed
10.Yoon, P, Steiner, I, Reinhardt, G. Analysis of factors influencing length of stay in the emergency department. Can J Emerg Med 2003;5(3):155–61.CrossRefGoogle ScholarPubMed
11.Bates, DW, Boyle, DL, Vander Vliet, MB, et al. Relationship between medication errors and adverse drug events. J Gen Intern Med 1995;10:199–205.CrossRefGoogle ScholarPubMed
12.Nettleman, MD, Bock, MJ. The epidemiology of missed medication doses in hospitalized patients. Clin Perform Qual Health Care 1996;4:148–53.Google ScholarPubMed