Department of Surgery, University of Louisville, KY.
Department of Surgery, Division of Surgical Oncology, University of Louisville, KY.
Surgery. 2021 Mar;169(3):567-572. doi: 10.1016/j.surg.2020.08.022. Epub 2020 Oct 1.
There is an increasing trend toward regionalization of emergency general surgery, which burdens patients. The absence of a standardized, emergency general surgery transfer algorithm creates the potential for unnecessary transfers. The aim of this study was to evaluate clinical reasoning prompting emergency general surgery transfers and to initiate a discussion for optimal emergency general surgery use.
Consecutive emergency general surgery transfers (December 2018 to May 2019) to 2 tertiary centers were prospectively enrolled in an institutional review board-approved protocol. Clinical reasoning prompting transfer was obtained prospectively from the accepting/consulting surgeon. Patient outcomes were used to create an algorithm for emergency general surgery transfer.
Two hundred emergency general surgery transfers (49% admissions, 51% consults) occurred with a median age of 59 (18 to 100) and body mass index of 30 (15 to 75). Insurance status was 25% private, 45% Medicare, 21% Medicaid, and 9% uninsured. Weekend transfers (Friday to Sunday) occurred in 45%, and 57% occurred overnight (6:00 pm to 6:00 am). Surgeon-to-surgeon communication occurred with 22% of admissions. Pretransfer notification occurred with 10% of consults. Common transfer reasons included no surgical coverage (20%), surgeon discomfort (24%), or hospital limitations (36%). A minority (36%) underwent surgery within 24 hours; 54% did not require surgery during the admission. Median length of stay was 6 (1 to 44) days.
Conditions prompting emergency general surgery transfers are heterogeneous in this rural state review. There remains an unmet need to standardize emergency general surgery transfer criteria, incorporating patient and hospital factors and surgeon availability. Well-defined requirements for communication with the accepting surgeon may prevent unnecessary transfers and maximize resource allocation.
急诊普通外科的区域化趋势日益明显，给患者带来了负担。由于缺乏标准化的急诊普通外科转科算法，可能会导致不必要的转科。本研究旨在评估促使急诊普通外科转科的临床推理，并为最佳的急诊普通外科使用展开讨论。
连续纳入 2018 年 12 月至 2019 年 5 月期间转诊至 2 家三级医院的连续急诊普通外科转科患者，前瞻性地纳入机构审查委员会批准的方案中。前瞻性地从接收/咨询外科医生处获得转科的临床推理。使用患者结局创建急诊普通外科转科算法。
共发生 200 例急诊普通外科转科（49%为入院，51%为会诊），患者中位年龄为 59 岁（18 至 100 岁），体重指数为 30（15 至 75）。保险状态为私人保险 25%、医疗保险 45%、医疗补助 21%和无保险 9%。周末（周五至周日）转科占 45%，夜间（下午 6 点至早上 6 点）转科占 57%。22%的入院患者进行了医生间的沟通。10%的会诊进行了转科前通知。常见的转科原因包括无外科医生（20%）、外科医生不适（24%）或医院限制（36%）。少数（36%）患者在 24 小时内接受手术；54%的患者在住院期间无需手术。中位住院时间为 6 天（1 至 44 天）。
在本农村州的回顾性研究中，促使急诊普通外科转科的条件是多样的。仍需要标准化急诊普通外科转科标准，纳入患者和医院因素以及外科医生的可用性。与接收外科医生进行明确的沟通要求，可能会防止不必要的转科并优化资源分配。
