Transfer of acute care surgery patients in a rural state: a concerning trend

Brittany Misercola; Kristen Sihler; Molly Douglas; Stephen Ranney; Jonathan Dreifus

doi:10.1016/j.jss.2016.06.090

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Transfer of acute care surgery patients in a rural state: a concerning trend

Journal article

Peer reviewed

Transfer of acute care surgery patients in a rural state: a concerning trend

Brittany Misercola, Kristen Sihler, Molly Douglas, Stephen Ranney and Jonathan Dreifus

The Journal of surgical research, Vol.206(1), pp.168-174

11/01/2016

DOI: 10.1016/j.jss.2016.06.090

PMID: 27916358

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Abstract

Regionalized care of complex patients to larger hospitals is an increasingly common practice as the population ages and the physician shortage evolves. The Acute Care Surgery model is new, and there are limited data on the patients being transferred through this system. We hypothesized transfer patients would be older, more complex, and require additional resources. Retrospective chart review of Acute Care Surgery patients admitted to a single tertiary facility. Patient demographics, clinical presentation, and outcomes were obtained. We found that our 161 transferred patients (TPs) were older (61.2 versus 54.7 y [P < 0.001]), had more comorbidities (Charlson Comorbidity Index 4 versus 3.1 [P < 0.001]), and required more resources than 611 local patients (LP; length of stay 8.2 versus 3.4 [P < 0.001], intensive care unit admission 24% versus 6% of patients [P < 0.001]). Admission diagnosis was similar, with pancreaticobiliary (TP 29% versus LP 30%) and small bowel (TP 25% versus LP 23%) complaints most common. Most common intervention was laparoscopic cholecystectomy for both (29% versus 25%). Subspecialty interventions were similar (IR, advanced endoscopy) at TP 10% and LP 8%. TPs were more likely to not require a procedure (31% versus 23%). Insurance provider differed between groups, particularly for Medicare (55% versus 34%) and privately insured (26% versus 45%). Although this study confirms transfer patients need the resources for which they were referred to a tertiary center, we unexpectedly found nearly half of transfer patients undergo basic surgical procedures or do not require intervention. This points to a concerning lack of general surgery resources in the community.

Adolescent

Adult

Aged

Aged, 80 and over

Critical Care

Female

Health Services Accessibility - statistics & numerical data

Humans

Length of Stay - statistics & numerical data

Maine

Male

Middle Aged

Patient Transfer - statistics & numerical data

Retrospective Studies

Rural Health Services - organization & administration

Rural Health Services - statistics & numerical data

Surgical Procedures, Operative - statistics & numerical data

Tertiary Care Centers - organization & administration

Tertiary Care Centers - statistics & numerical data

Young Adult

Details

Title: Subtitle: Transfer of acute care surgery patients in a rural state: a concerning trend
Creators: Brittany Misercola - Maine Medical Center
Kristen Sihler - Maine Medical Center
Molly Douglas - Maine Medical Center
Stephen Ranney - Maine Medical Center
Jonathan Dreifus - Maine Medical Center
Resource Type: Journal article
Publication Details: The Journal of surgical research, Vol.206(1), pp.168-174
DOI: 10.1016/j.jss.2016.06.090
PMID: 27916358
ISSN: 0022-4804
eISSN: 1095-8673
Language: English
Date published: 11/01/2016
Academic Unit: Surgery
Record Identifier: 9984746240002771

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28 Times Cited - Web of Science

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