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Capacity-related interfacility patient transports: patients affected, wait times involved and associated morbidity

Published online by Cambridge University Press:  21 May 2015

Esther Stolte ,
Rod Iwanow  and
Christine Hall
Esther Stolte
Affiliation:
Family Medicine Resident, Queen's University, Kingston, Ont.
Rod Iwanow
Affiliation:
Department of Emergency Medicine, Calgary Health Region, Calgary, Alta.
Christine Hall*
Affiliation:
Department of Emergency Medicine, Calgary Health Region, Calgary, Alta.
*
Department of Emergency Medicine, Room C231, Foothills Hospital, 1403 29 St. NW, Calgary AB T2N 2T9

Abstract

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Objectives:

The trend toward operating Canadian hospitals at full capacity necessitates in some settings the transfer of patients from one hospital's emergency department (ED) to another hospital for admission, due to lack of bed availability at the first hospital. Our objectives were to determine how many and which patients are transported, to measure how much time is spent in the peri-transport process and to document any morbidity or mortality associated with these periods of transitional care.

Methods:

In this retrospective, observational health records review, we obtained health records during February, June and October 2002 for patients evaluated in any 1 of 3 adult EDs from a single Canadian city and subsequently transferred for admission to 1 of the other 2 hospitals. Data included the reason for transport, admitting service, transport process times and administration of key medications (asthma, cardiac, diabetes, analgesic or antibiotics).

Results:

Five hundred and thirteen records of transported patients were reviewed, and 507 were evaluated. Of those, 372 (73.4%) transfers were capacity-related and 135 (26.6%) were transferred for specialty services. Of the capacity transports, 219 (58.9%) were admissions for psychiatry and 123 (33.1%) for medicine. Median wait time at the first hospital was 6.7 hours, being longest for psychiatric patients. Thirty patients (8.1%) missed 1 or more doses of a key medication in the peri-transport process, and 8 (2.2%) missed 2 or more.

Conclusions:

Overcrowding of hospitals is a significant problem in many Canadian EDs, resulting in measurable increases in lengths of stay. Transfers arranged to other facilities for admission further prolong lengths of stay. Increased boarding times can result in missed medications, which may increase patient morbidity. Further study is needed to assess the need for capacity transfers and the possible risk to patients associated with periods of transitional care.

Keywords

interfacility transfercapacity
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 4 , July 2006 , pp. 262 - 268
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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