• Biswadev Mitra, Annie Carter, Smit De Villiers V Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia. Nat, Fatima Rahman, Shane O'Donovan, Alexander Olaussen, Jiun Kae Pui, Jeremy Abetz, Peter Hunter, and Peter A Cameron.
• Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2020 Feb 1; 32 (1): 61-66.

ObjectivesTo determine the population of patients where patient transfer may be prevented by assessment of a senior ED registrar at the referring hospital.MethodsPatients transferred from Caulfield Hospital, specialising in community services, rehabilitation, aged care and aged mental health to The Alfred Emergency and Trauma Centre, an adult major referral centre within the same clinical network were identified from 1 July 2016 to 31 December 2016. Medical records were reviewed independently by two clinicians to determine preventability of transfer and whether attendance by a senior ED registrar could have prevented the transfer.ResultsThere were 221 patients included with a mean age of 73.6(15.1) years. The median time spent in the ED was 4 h (interquartile range 2-8) and 197 (89.1%) were admitted. There were 107 (48.6%) transfers deemed preventable or potentially preventable, with 104 preventable by attendance of a senior ED registrar. The most common indication for transfer was acute trauma (n = 55; 24.9%), and the odds of a case being preventable or potentially preventable if transferred for the primary indication of trauma was 3.9 (95% confidence interval 2.1-7.1; P < 0.001). Among the preventable cases, the total cost of transfer was AU$105 984 over 6 months, not accounting for the costs of duplication of care.ConclusionsThis proof-of-concept study suggests that strategies to expand the provision of acute care to outreach within specialist networks and reduce patient transfers should be further explored. An outreach programme for improved acute assessment of patients at the referring hospital particularly after acute trauma may prevent transfers, improving care pathways.© 2019 Australasian College for Emergency Medicine.

18 keywords...

hide…