title: Challenges in arranging interhospital transfer from a non-tertiary hospital emergency department in the Perth metropolitan area.
abstract: OBJECTIVE
  To describe the organisational demands on staff when arranging interhospital transfers (IHTs) from an ED.
  
  
  METHODS
  Prospective observational study of IHTs from three non-tertiary hospital EDs in the Perth metropolitan area. Data were collected over 14 consecutive days commencing 20 January, 26 March and 6 July 2010 for each respective site. Outcome measures were the time taken for transfer acceptance, the number of telephone calls required and the perceived degree of difficulty to arrange a transfer.
  
  
  RESULTS
  We examined 229 (70%) of the 325 IHTs conducted during the study period. Transfers took 1-11 telephone calls to arrange (median 2). More calls were required for urgent (median 4, IQR 3.5-9.4, n = 69) than non-urgent IHTs (median 3, IQR 2-4, n = 160, P = 0.04). Four or more calls were required in 23.5% of cases (n = 54) with 20 (9%) of these involving critically ill patients. The median time to transfer acceptance was similar for urgent (10 min, IQR 4-24, n = 69) and non-urgent IHTs (10 min, IQR 5-23, P = 0.48, n = 155). A post-hoc analysis describing IHTs that took over 1 h to organise, showed that urgent transfers took 155 min (IQR 132-213) compared with 120 min for non-urgent IHTs (IQR 79-157; P = 0.07). Arranging an IHT was perceived to be challenging in 6% of cases with the clarity of decision-making, receiving staff understanding of the limitations of referral hospital services and the effect of delays of prime importance.
  
  
  CONCLUSIONS
  While most IHTs are straightforward, critically ill transfers require considerable time, effort and teamwork to arrange.
authors.affiliation: Education Department, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gillman
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fatovich
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration*; D011446:Prospective Studies; D014904:Western Australia
keywords: ED; health services accessibility; interhospital transfer; patient transfer