title: The Effect of Treatment Delays Associated with Inpatient Inter-hospital Transfer from Peripheral to Tertiary Hospitals for the Surgical Treatment of Cardiology Patients.
abstract: BACKGROUND
  Nearly 100,000 presentations to non-tertiary hospitals per year result in an inpatient transfer [1]. The timely inter-hospital transfer of patients for cardiothoracic surgery is significant to their overall outcomes. We hypothesised that patients with a prolonged pre-operative admission were at risk of nosocomial infection, leading to prolonged hospitalisation, morbidity and mortality.
  
  
  METHODS
  Patients admitted to a non-tertiary centre (Frankston Hospital, Group 1) and requiring transfer to tertiary centres for cardiac surgery were compared to patients presenting directly to tertiary centres (Alfred Hospital, Group 2; St Vincent's Hospital, Group 3) from June 2011-July 2012. Data was obtained from medical records and the National Cardiac Surgery Database.
  
  
  RESULTS
  Eighty-seven patients in Group 1, 78 patients in Group 2 and 65 patients in Group 3 were identified. A higher proportion of total admission time was spent awaiting surgery in Group 1 compared to Group 2 (52.8% vs. 38.3%, p≤0.001) and Group 3 (52.8% vs. 26.3%, p≤0.001). Nosocomial infections occurred more frequently in Group 1 compared to Group 2 (20.7% vs. 5.1%, p=0.04) and Group 3 (20.7% vs. 6%, p<0.001).
  
  
  CONCLUSIONS
  Presentation to a non-tertiary centre requiring inpatient cardiothoracic surgery is associated with longer pre-operative waiting time and higher rates of hospital-acquired infections.
authors.affiliation: Alfred Hospital, Melbourne, Vic, Australia; Peninsula Health, Frankston, Vic, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Prabhu
authors.affiliation: Alfred Hospital, Melbourne, Vic, Australia. Electronic address: davidblusztein@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Blusztein
authors.affiliation: Peninsula Health, Frankston, Vic, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Jackson
authors.affiliation: Alfred Hospital, Melbourne, Vic, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Sharma
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Arunothayaraj
authors.affiliation: St Vincent's Hospital, Melbourne, Vic, Australia; Peninsula Health, Frankston, Vic, Australia.
authors.forename: M B
authors.initials: MB
authors.lastname: Stokes
authors.affiliation: Alfred Hospital, Melbourne, Vic, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Kras
authors.affiliation: Peninsula Health, Frankston, Vic, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Yi
authors.affiliation: Peninsula Health, Frankston, Vic, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Kong
authors.affiliation: Peninsula Health, Frankston, Vic, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Haji
authors.affiliation: Alfred Hospital, Melbourne, Vic, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Peck
authors.affiliation: Alfred Hospital, Melbourne, Vic, Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Casan
authors.affiliation: Alfred Hospital, Melbourne, Vic, Australia; Peninsula Health, Frankston, Vic, Australia.
authors.forename: G D
authors.initials: GD
authors.lastname: Toogood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D003428:Cross Infection / Q000453:epidemiology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010360:Patient Transfer; D057234:Preoperative Period; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: Cardiac Surgical Procedures; Cardiovascular Diseases; Infection; Public Health; Regional health planning