Russell Patrick, Hakendorf Paul, Thompson Campbell
Department of General Medicine, Flinders Medical Centre, 1 Bedford Drive, Bedford Park, SA 5042, Australia.
Clinical Epidemiology Unit, Flinders Medical Centre, 1 Bedford Drive, Bedford Park, SA 5042, Australia. Email.
Aust Health Rev. 2015 Sep;39(4):400-403. doi: 10.1071/AH14216.
The aim of the present study was to assess the effect of an inter-hospital transfer on efficiency and quality of in-patient care.
A retrospective cohort study from 2010 to 2012 inclusive was conducted in two tertiary-referral urban hospitals within a single area healthcare network. The study included 14 571 acutely unwell patients admitted to a general medical service. The main outcome measures were length of in-patient stay, relative stay index, readmission rate within 7 and 28 days of discharge and in-hospital mortality rate.
Compared with patients who were transferred to a long-stay ward within the original hospital (n = 3465), transferred patients (n = 1531) were older (71 vs 80 years, respectively; P < 0.001) but suffered less comorbidity (Charlson index 0.84 vs 1.22, respectively; P < 0.001). Transferred patients spent a shorter time in hospital (5.69 vs 6.25 days; P < 0.001) and were less likely to be re-admitted within 7 days (1.5% vs 4.0%; P < 0.001) or 28 days (6.3% vs 9.3%; P < 0.001) than patients who were not transferred. Mortality was lower in the transferred patients (1.1% vs 4.1%).
Appropriate patients for inter-hospital transfer can be selected within 24 h of arrival at an index hospital. The efficiency of their care at the receiving hospital appears not to be compromised. The present study provides support for inter-hospital transfer as a strategy to optimise regional bed capacity.
本研究旨在评估医院间转运对住院治疗效率和质量的影响。
对2010年至2012年（含）期间在单一区域医疗网络内的两家三级转诊城市医院进行了一项回顾性队列研究。该研究纳入了14571名入住普通内科的急性病患者。主要观察指标为住院时间、相对住院指数、出院后7天和28天内的再入院率以及住院死亡率。
与在原医院转入长期病房的患者（n = 3465）相比，转院患者（n = 1531）年龄更大（分别为71岁和80岁；P < 0.001），但合并症较少（Charlson指数分别为0.84和1.22；P < 0.001）。转院患者的住院时间较短（5.69天对6.25天；P < 0.001），且在7天（1.5%对4.0%；P < 0.001）或28天（6.3%对9.3%；P < 0.001）内再次入院的可能性低于未转院患者。转院患者的死亡率较低（1.1%对4.1%）。
在到达索引医院24小时内可以选择合适的患者进行医院间转运。他们在接收医院的治疗效率似乎并未受到影响。本研究为医院间转运作为优化区域床位容量的策略提供了支持。
