Challenges in arranging interhospital transfer from a non‐tertiary hospital emergency department in the <scp>P</scp>erth metropolitan area

Abstract

OBJECTIVE: To describe the organisational demands on staff when arranging interhospital transfers (IHTs) from an ED. METHOD: Prospective observational study of IHTs from three non-tertiary hospital EDs in the Perth metropolitan area. Data were collected over 14 consecutive days commencing 20 January, 26 March and 6 July 2010 for each respective site. Outcome measures were the time taken for transfer acceptance, the number of telephone calls required and the perceived degree of difficulty to arrange a transfer. RESULTS: We examined 229 (70%) of the 325 IHTs conducted during the study period. Transfers took 1-11 telephone calls to arrange (median 2). More calls were required for urgent (median 4, IQR 3.5-9.4, n = 69) than non-urgent IHTs (median 3, IQR 2-4, n = 160, P = 0.04). Four or more calls were required in 23.5% of cases (n = 54) with 20 (9%) of these involving critically ill patients. The median time to transfer acceptance was similar for urgent (10 min, IQR 4-24, n = 69) and non-urgent IHTs (10 min, IQR 5-23, P = 0.48, n = 155). A post-hoc analysis describing IHTs that took over 1 h to organise, showed that urgent transfers took 155 min (IQR 132-213) compared with 120 min for non-urgent IHTs (IQR 79-157; P = 0.07). Arranging an IHT was perceived to be challenging in 6% of cases with the clarity of decision-making, receiving staff understanding of the limitations of referral hospital services and the effect of delays of prime importance. CONCLUSION: While most IHTs are straightforward, critically ill transfers require considerable time, effort and teamwork to arrange.