title: Achieving regionalization through rural interhospital transfer.
abstract: Regionalization of emergency medical care aims to provide consistent and efficient high-quality care leading to optimal clinical outcomes by matching patient needs with appropriate resources at a network of hospitals. Regionalized care has been shown to improve outcomes in trauma, myocardial infarction, stroke, cardiac arrest, and acute respiratory distress syndrome. In rural areas, effective regionalization often requires interhospital transfer. The decision to transfer is complex and includes such factors as capabilities of the presenting hospital; capacity at the receiving hospital; and financial, geographic, and patient-preference considerations. Although transfer to a comprehensive center has proven benefits for some conditions, the transfer process is not without risk. These risks include clinical deterioration, limited resource availability during transport, vehicular crashes, time delays for time-sensitive care, poor communication between providers, and neglect of patient preferences. This article reviews the transfer decision, financial implications, risks, and considerations for patients undergoing rural interhospital transfer. We identify several strategies that should be considered for development of the regionalized emergency health care system of the future and identify areas where further research is necessary.
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Feazel
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Schlichting
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Bell
authors.affiliation: Department of Health Management and Policy, College of Public Health, Iowa City, IA, USA.
authors.forename: Dan M
authors.initials: DM
authors.lastname: Shane
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Department of Pharmacy, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Faine
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nugent
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA. Electronic address: nicholas-mohr@uiowa.edu.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D010360:Patient Transfer / Q000458:organization & administration*; D012041:Regional Medical Programs / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*