title: Critical access hospital ED to quaternary medical center: successful implementation of an integrated Picture Archiving and Communications System for patient transfers by air and sea.
abstract: OBJECTIVE
  The purpose of this study was to investigate the role of imaging in transfers between an island Critical Access Hospital (CAH) emergency department (ED) and a quaternary care hospital.
  
  
  METHODS
  Electronic medical records were reviewed to identify all patients who were transferred from an island CAH to our quaternary care hospital in 2012 and 2013. Medical history, transfer diagnosis, and the type of imaging performed at the CAH prior to transfer were reviewed.
  
  
  RESULTS
  During the study period, a total of 22075 ED visits were made to the CAH and 696 (3.2%) of these patients were transferred for higher level of care, with 424 (60.9%) of the patients transferred to our quaternary care hospital. The most common reasons for transfer were cardiac (121; 28.5%), trauma (82; 19.3%), gastrointestinal (63; 14.9%), and neurologic conditions (54; 12.7%). 349 patients (82.3%) had imaging prior to transfer (56.4% radiograph, 33.5% computed tomography, 4.7% magnetic resonance imaging, 8.0% ultrasound). Of patients that had imaging, 53.6% had positive imaging findings related to the transfer diagnosis, and patients transferred for noncardiac etiologies were significantly more likely to have imaging findings related to their transfer diagnosis compared with patients transferred for cardiac etiologies (72.9% vs 6.9%, respectively; P< .0001).
  
  
  CONCLUSIONS
  Approximately 3 of every 100 ED visits to the rural CAH required transfer for higher level of care, with nearly three-quarters of noncardiac transferred patients having a positive imaging finding related to the reason for transfer.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: aprabhakar@mgh.harvard.edu.
authors.forename: Anand M
authors.initials: AM
authors.lastname: Prabhakar
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: H Benjamin
authors.initials: HB
authors.lastname: Harvey
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA.
authors.forename: Katelyn N
authors.initials: KN
authors.lastname: Brinegar
authors.affiliation: Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Nantucket Cottage Hospital, Nantucket, MA.
authors.forename: James R
authors.initials: JR
authors.lastname: Kelly
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: James A
authors.initials: JA
authors.lastname: Brink
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saini
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Scottsdale, AZ.
authors.forename: Rahmi
authors.initials: R
authors.lastname: Oklu
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010360:Patient Transfer / Q000458:organization & administration*; D011873:Radiology Information Systems; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis*