title: Interhospital transfer for acute surgical care: does delay matter?
abstract: BACKGROUND
  Delays to definitive care are associated with poor outcomes after trauma and medical emergencies. It is unknown whether inter-hospital transfer delays affect outcomes for nontraumatic acute surgical conditions.
  
  
  METHODS
  We performed a retrospective cohort study of patient transfers for acute surgical conditions within a regional transfer network from 2009 to 2013. Delay was defined as more than 24 hours from presentation to transfer request and categorized as 1 or 2+ days. The primary outcome was post-transfer death or hospice. Bivariate and multivariable logistic regression were performed.
  
  
  RESULTS
  The cohort included 2,091 patient transfers. Delays of 2 or more days were associated with death or hospice in unadjusted analyses, but there was no difference after adjustment. Predictors of post-transfer death or hospice included older age, higher comorbidity scores, and greater severity of illness.
  
  
  CONCLUSIONS
  Delays in transfer request were not associated with post-transfer mortality or discharge to hospice, suggesting effective triage of nontraumatic acute surgical patients.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA; Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA; Department of Surgery, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA. Electronic address: kristy.l.kummerow@vanderbilt.edu.
authors.forename: Kristy
authors.initials: K
authors.lastname: Kummerow Broman
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Hayes
authors.affiliation: Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.affiliation: Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA; Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Phillips
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Holzman
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sharp
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA; Department of Surgery, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Pierce
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Nealon
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061214:Patient Safety; D018579:Patient Selection; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000379:methods / Q000401:mortality*; D062606:Tertiary Care Centers
keywords: Acute care surgery; Death; Delay; Hospice; Inter-hospital; Quality; Transfer