title: Interhospital Transfer of Neurosurgical Patients to a High-Volume Tertiary Care Center: Opportunities for Improvement.
abstract: BACKGROUND
  Neurosurgical indications for patient transfer include absence of local or available neurosurgical coverage, subspecialty or interdisciplinary requirements, and family preference. Transfer of patients to regional centers will increase with further centralization of medical care.
  
  
  OBJECTIVE
  To report the transfer records of a large tertiary care center to identify trends, failures, and opportunities to improve interhospital transfer of neurosurgical patients.
  
  
  METHODS
  All consecutive, prospectively documented requests for interhospital patient transfer to the adult neurosurgical service of Emory University Hospitals were retrospectively identified from a centralized transfer center database for a 1-year study period.
  
  
  RESULTS
  Requests for neurosurgical care constituted 1323 of the 9087 calls (14.6%); 81.1% of these requests were accepted, and a total of 984 patients (74.4%) arrived at our institutions. Patients arrived from 133 unique facilities throughout a catchment area of 66 287 sq miles. Although the median travel time for transfer patients was 36 minutes, the median interval between the request and patient arrival was 4 hours 2 minutes. The most frequent diagnoses were intracranial hemorrhage (31.8%), subarachnoid hemorrhage (31.2%), and intracranial tumor (15.2%). The overall diagnostic error rate was 10.3%. Only 42.5% of patients underwent neurosurgical intervention, and 57 patients admitted to intensive care were immediately transitioned to a lower level of care.
  
  
  CONCLUSIONS
  Interhospital transfer requires a coordinated effort among hospital administrators, physicians, and staff to make complex decisions that govern this important and costly process. These data suggest common failures and numerous opportunities for improvement in transfer efficiency, diagnostic accuracy, triage, and resource allocation.
authors.affiliation: *Department of Neurological Surgery, ‡Emory University School of Medicine, and §Department of Neurology, Emory University, Atlanta, Georgia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.forename: Evan W
authors.initials: EW
authors.lastname: McClure
authors.forename: Brian M
authors.initials: BM
authors.lastname: Howard
authors.forename: Owen B
authors.initials: OB
authors.lastname: Samuels
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Barrow
mesh_terms: D000328:Adult; D003422:Critical Care; D005845:Georgia; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000601:surgery; D009493:Neurosurgery / Q000458:organization & administration*; D019635:Neurosurgical Procedures / Q000379:methods*; D010342:Patient Acceptance of Health Care; D010360:Patient Transfer / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D013038:Specialization; D062606:Tertiary Care Centers / Q000458:organization & administration*; D016896:Treatment Outcome; D014218:Triage