Kindermann Dana R, Mutter Ryan L, Houchens Robert L, Barrett Marguerite L, Pines Jesse M
Department of Emergency Medicine, The Permanente Medical Group, Oakland, CA.
Acad Emerg Med. 2015 Feb;22(2):157-65. doi: 10.1111/acem.12586. Epub 2015 Jan 29.
The objective was to describe transfers out of hospital-based emergency departments (EDs) in the United States and to identify different characteristics of sending and receiving hospitals, travel distance during transfer, disposition on arrival to the second hospital, and median number of transfer partners among sending hospitals.
Emergency department records were linked at transferring hospitals to ED and inpatient records at receiving hospitals in nine U.S. states using the 2010 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases and State Inpatient Databases, the American Hospital Association Annual Survey, and the Trauma Information Exchange Program. Using the Clinical Classification Software (CCS) to categorize conditions, the 50 disease categories with the highest transfer rates were studied, and these were then placed into nine clinical groups. Records were included where both sending and receiving records were available; these data were tabulated to describe ED transfer patterns, hospital-to-hospital distances, final patient disposition, and number of transfer partners.
A total of 97,021 ED transfer encounters were included in the analysis from the 50 highest transfer rate disease categories. Among these, transfer rates ranged from 1% to 13%. Circulatory conditions made up about half of all transfers. Receiving hospitals were more likely to be nonprofit, teaching, trauma, and urban and have more beds with greater specialty coverage and more advanced diagnostic and therapeutic resources. The median transfer distance was 23 miles, with 25% traveling more than 40 to 50 miles. About 8% of transferred encounters were discharged from the second ED, but that varied from 0.6% to 53% across the 50 conditions. Sending hospitals had a median of seven transfer partners across all conditions and between one and four per clinical group.
Among high-transfer conditions in U.S. EDs, patients are often transferred great distances, more commonly to large teaching hospitals with greater resources. The large number of transfer partners indicates a possible lack of stable transfer relationships between U.S. hospitals.
本研究旨在描述美国医院急诊科（ED）的转出情况，并确定转出医院和接收医院的不同特征、转运期间的行程距离、抵达第二家医院时的处置方式，以及转出医院之间转运伙伴的中位数。
利用2010年医疗成本与利用项目（HCUP）的州急诊科数据库和州住院患者数据库、美国医院协会年度调查以及创伤信息交换项目，将美国九个州的转出医院的急诊科记录与接收医院的急诊科和住院患者记录相链接。使用临床分类软件（CCS）对病情进行分类，研究了转出率最高的50种疾病类别，然后将其分为九个临床组。纳入有转出和接收记录的病例；将这些数据制成表格，以描述急诊科的转运模式、医院之间的距离、患者最终处置情况以及转运伙伴数量。
分析纳入了50种转出率最高的疾病类别中的97,021次急诊科转运病例。其中，转出率在1%至13%之间。循环系统疾病约占所有转运病例的一半。接收医院更有可能是非营利性、教学型、创伤中心且位于城市，拥有更多床位、更广泛的专科覆盖以及更先进的诊断和治疗资源。转运的中位数距离为23英里，25%的患者行程超过40至50英里。约8%的转运病例从第二家急诊科出院，但在这50种疾病中，该比例从0.6%到53%不等。转出医院在所有疾病类别中的转运伙伴中位数为7个，每个临床组为1至4个。
在美国急诊科转出率较高的疾病中，患者通常被转运到距离较远的地方，更常见的是转至资源更丰富的大型教学医院。大量的转运伙伴表明美国医院之间可能缺乏稳定的转运关系。
