Broman Kristy Kummerow, Poulose Benjamin K, Phillips Sharon E, Ehrenfeld Jesse M, Sharp Kenneth W, Pierce Richard A, Holzman Michael D
Department of Surgery, Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am Surg. 2016 Aug;82(8):672-8.
Interhospital transfers for acute surgical care occur commonly, but without clear guidelines or protocols. Transfers may subject patients and delivery systems to significant burdens without clear clinical benefit. The incidence and factors associated with unnecessary transfers are not well described. We conducted a retrospective cohort study of patient transfers within a regional referral network to a tertiary center for nontrauma acute surgical care from 2009 to 2013. Clinically unnecessary transfers were defined as transfers that resulted in no intervention (operation, endoscopy, or interventional radiology procedure) and discharge to home within 72 hours. We performed bivariate and multivariate logistic regression analyses. The study population included 2177 patient transfers, 19 per cent of which were determined to be clinically unnecessary. After adjustment, clinically unnecessary transfers were more commonly performed for patient request (odds ratio = 2.52, 95% confidence interval = 1.60-3.99), continuity of care (1.87, 1.44-2.42), and care by urologic (1.50, 1.06-2.13) and vascular services (1.44, 1.03-2.01). Patients with higher comorbidity and severity of illness scores were less likely to have unnecessary transfers. The burden of unnecessary transfers could be mitigated by identifying appropriate transfer candidates through mutually developed guidelines, interfacility collaboration, and increased use of remote care to provide surgical subspecialty consultation and maintain continuity.
急性外科护理的院际转运很常见，但缺乏明确的指南或方案。转运可能会给患者和医疗服务系统带来巨大负担，却没有明显的临床益处。不必要转运的发生率及相关因素尚未得到充分描述。我们对2009年至2013年期间在一个区域转诊网络内转至一家三级中心接受非创伤性急性外科护理的患者进行了一项回顾性队列研究。临床上不必要的转运被定义为那些在72小时内未导致任何干预（手术、内镜检查或介入放射学操作）且出院回家的转运。我们进行了双变量和多变量逻辑回归分析。研究人群包括2177例患者转运，其中19%被确定为临床上不必要的。经过调整后，临床上不必要的转运更常见于患者要求（比值比=2.52，95%置信区间=1.60-3.99）、医疗连续性（1.87，1.44-2.42）以及泌尿外科（1.50，1.06-2.13）和血管外科服务（1.44，1.03-2.01）。合并症和疾病严重程度评分较高的患者进行不必要转运的可能性较小。通过共同制定指南、机构间协作以及增加使用远程护理来提供外科专科会诊并维持连续性，可以减轻不必要转运的负担。
