Timing of emergency interhospital transfers from subacute to acute care and patient outcomes: A prospective cohort study
Section snippets
What is already known about the topic?
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Despite the important role of subacute care in the Australian healthcare system, there is a dearth of research related to the care and outcomes of patients in the subacute care sector
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Approximately 10% of rehabilitation care admissions result in transfer to an acute care hospital, however issues related to transition between acute and subacute sectors and patient movement between acute and subacute care hospitals is poorly understood
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Unexpected transfers from inpatient rehabilitation hospitals to
What this paper adds
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Patients with early and late emergency interhospital transfers from subacute to acute care had similar demographic and comorbidity profiles and similar acute care admission characteristics prior to subacute care admission
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Readmission to acute care hospital was the most common transfer outcome in both groups suggesting that transfer was warranted and the lower mortality in early transfer patients suggests emergency interhospital transfers have a patient safety benefit
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Early transfer patients had
Method
This prospective, exploratory cohort study is a subanalysis of data derived from a larger case-time-control study (Suissa, 1995) conducted across 21 wards of eight subacute care facilities located within five major health services in Victoria, Australia (Considine et al., 2018). All subacute care hospitals in this study were geographically separate from their health services’ acute care hospitals. The inclusion criterion was all patients with an emergency interhospital transfer from inpatient
Results
There were 54 early transfers in 48 patients (four patients had two transfers and one patient had three transfers) and 548 late transfers in 505 patients (39 patients had two transfers and two patients had three transfers) and there was one transfer in which the exact timing could not be accurately determined, leaving a sample of 602 transfers. The median length of stay in subacute care prior to transfer time was 16.3 h for early transfers and 211 h (8.8 days) for late transfers. The patient
Discussion
In this study, two transitions in care: subacute care admission (planned movement of the patient from an acute care to a subacute care hospital) and emergency interhospital transfer from the subacute care to an acute care hospital were analysed in relation to time of emergency interhospital transfer from the subacute care facility. Key differences between early and late transfer patients were that early transfer patients were less likely to have a limitation of treatment order at any time
Conclusion
Patients with early and late emergency interhospital transfers from subacute to acute care had similar demographic and comorbidity profiles and similar acute care admission characteristics prior to transition to subacute care hospitals. Acute care hospital readmission was the most common transfer outcome in both groups suggesting that transfer was warranted. Further, early transfer patients had lower in-patient mortality so emergency interhospital transfers, while resource intensive, appear to
Funding
This work was supported by a Deakin University School of Nursing and Midwifery grant.
Competing interests
There are no conflicts of interest to declare. No author had any financial or professional relationships which may pose a competing interest to the study or decision to submit the manuscript for publication.
Acknowledgements
The authors wish to thank Adjunct Professors David Plunkett, Cheyne Chalmers, Sharon Donovan, Janet Weir-Phyland and Lucy Cuddihy for their support of this work and Renata Mistarz RN, Sam Xenos RN, Sue Streat RN, Joanne Stafford RN, Kath Colvin RN and Lee Hughes RN for their assistance with data collection.
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