Double inter-hospital transfer in Sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer

Maria D. Arulraja; Morgan B. Swanson; Nicholas M. Mohr

doi:10.1016/j.jcrc.2019.11.018

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Double inter-hospital transfer in Sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer

Journal article

Peer reviewed

Double inter-hospital transfer in Sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer

Maria D. Arulraja, Morgan B. Swanson and Nicholas M. Mohr

Journal of critical care, Vol.56, pp.49-57

04/2020

DOI: 10.1016/j.jcrc.2019.11.018

PMCID: PMC7080611

PMID: 31837601

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https://www.ncbi.nlm.nih.gov/pmc/articles/7080611View

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Abstract

Sepsis is a leading cause of hospital deaths. Inter-hospital transfer is frequent in sepsis and is associated with increased mortality. Some sepsis patients undergo two inter-hospital transfers (double transfer). This study assessed the (1) prevalence, (2) associated risk factors, (3) associated mortality, and (4) hospital length-of-stay and costs of double-transfer of sepsis patients. Retrospective cohort study using 2005–2014 administrative claims data in Iowa. Multivariable generalized estimating equations adjusted for potential confounding variables, with a primary outcome of mortality. Secondary outcomes included hospital length-of-stay and costs. Hospital-specific cost-to-charge ratios estimated hospital costs. Hospitals were categorized into quintiles based on sepsis-volume. Of 15,182 sepsis subjects, there were 45.2% non-transfers and 2.1% double-transfers. Double-transfers had worse mortality than non-transfers but not single-transfers. Of the non-transfers, 44.9% presented to a top sepsis-volume hospital compared to 22.8% of double-transfers and 25.1% of single-transfers. After transfer from first to second hospital, 93.4% of the single-transfers and 92.2% of the double-transfers were at a top sepsis-volume hospital. Double-transfers had longer length-of-stay and more in total hospital costs than single-transfers. Double-transfer occurs in 2.1% of Iowa sepsis patients. Double-transfers had similar mortality and increased length of stay and costs compared to single-transfers. •Double-transfer occurs in 2.1% of severe sepsis and septic shock patients.•No mortality differences were observed between double-and single-transfer.•Higher healthcare costs and length-of-stay were observed in double-transfer.•Minimizing double-transfer could reduce the health care burden of sepsis.

Critical care

Delivery of health care

Emergency medicine

Patient transfer

Sepsis

Details

Title: Subtitle: Double inter-hospital transfer in Sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer
Creators: Maria D. Arulraja - Roy J. and Lucille A. Carver College of Medicine
Morgan B. Swanson - University of Iowa
Nicholas M. Mohr - Roy J. and Lucille A. Carver College of Medicine
Resource Type: Journal article
Publication Details: Journal of critical care, Vol.56, pp.49-57
DOI: 10.1016/j.jcrc.2019.11.018
PMID: 31837601
PMCID: PMC7080611
NLM abbreviation: J Crit Care
ISSN: 0883-9441
eISSN: 1557-8615
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100002076, name: Emergency Medicine Foundation; DOI: 10.13039/100008893, name: University of Iowa; DOI: 10.13039/100008893, name: University of Iowa; DOI: 10.13039/100000002, name: National Institutes of Health; name: Clinical and Translational Science Award, award: U54TR001356; DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: K08HS025753
Language: English
Date published: 04/2020
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984295946602771

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