Potentially avoidable inter-facility transfer from Veterans Health Administration emergency departments: A cohort study

Nicholas M Mohr; Chaorong Wu; Michael J Ward; Candace D McNaughton; Kelly Richardson; Peter J Kaboli

doi:10.1186/s12913-020-4956-6

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Potentially avoidable inter-facility transfer from Veterans Health Administration emergency departments: A cohort study

Journal article

Open access

Peer reviewed

Potentially avoidable inter-facility transfer from Veterans Health Administration emergency departments: A cohort study

Nicholas M Mohr, Chaorong Wu, Michael J Ward, Candace D McNaughton, Kelly Richardson and Peter J Kaboli

BMC health services research, Vol.20(1), pp.110-110

02/12/2020

DOI: 10.1186/s12913-020-4956-6

PMCID: PMC7014752

PMID: 32050947

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Abstract

Inter-facility transfer is an important strategy for improving access to specialized health services, but transfers are complicated by over-triage, under-triage, travel burdens, and costs. The purpose of this study is to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. This observational cohort study included all patients treated in VHA EDs between 2012 and 2014 who were transferred to another VHA hospital. Potentially avoidable transfers were defined as patients who were either discharged from the receiving ED or admitted to the receiving hospital for ≤1 day without having an invasive procedure performed. We conducted facility- and diagnosis-level analyses to identify subgroups of patients for whom potentially avoidable transfers had increased prevalence. Of 6,173,189 ED visits during the 3-year study period, 18,852 (0.3%) were transferred from one VHA ED to another VHA facility. Rural residents were transferred three times as often as urban residents (0.6% vs. 0.2%, p < 0.001), and 22.8% of all VHA-to-VHA transfers were potentially avoidable transfers. The 3 disease categories most commonly associated with inter-facility transfer were mental health (34%), cardiac (12%), and digestive diagnoses (9%). VHA inter-facility transfer is commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.

United States

Adult

Aged

Cohort Studies

Emergency Service, Hospital

Female

Health Services Research

Humans

Male

Middle Aged

Patient Transfer - statistics & numerical data

United States Department of Veterans Affairs

Details

Title: Subtitle: Potentially avoidable inter-facility transfer from Veterans Health Administration emergency departments: A cohort study
Creators: Nicholas M Mohr - Roy J. and Lucille A. Carver College of Medicine
Chaorong Wu - University of Iowa
Michael J Ward - Vanderbilt University Medical Center
Candace D McNaughton - Vanderbilt University Medical Center
Kelly Richardson - Iowa City VA Health Care System
Peter J Kaboli - University of Iowa
Resource Type: Journal article
Publication Details: BMC health services research, Vol.20(1), pp.110-110
DOI: 10.1186/s12913-020-4956-6
PMID: 32050947
PMCID: PMC7014752
NLM abbreviation: BMC Health Serv Res
ISSN: 1472-6963
eISSN: 1472-6963
Grant note: CIN 13-412 / U.S. Department of Veterans Affairs W81XWH-17-C-0252 / U.S. Department of Defense K23 HL127130 / NHLBI NIH HHS ORH-10708 / U.S. Department of Veterans Affairs K08 HS025753 / AHRQ HHS K23 HL125670 / NHLBI NIH HHS
Language: English
Date published: 02/12/2020
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984296132102771

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