title: Interhospital Transfer of Neurosurgical Patients: Implications of Timing on Hospital Course and Clinical Outcomes.
abstract: BACKGROUND
  Interhospital transfer of neurosurgical patients is common; however, little is known about the impact of transfer parameters on clinical outcomes. Lower survival rates have been reported for patients admitted at night and on weekends in other specialties. Whether time or day of admission affects neurosurgical patient outcomes, specifically those transferred from other facilities, is unknown.
  
  
  OBJECTIVE
  To examine the impact of the timing of interhospital transfer on the hospital course and clinical outcomes of neurosurgical patients.
  
  
  METHODS
  All consecutive admissions of patients transferred to our adult neurosurgical service were retrospectively analyzed for a 1-year study period using data from a central transfer database and the electronic health record.
  
  
  RESULTS
  Patients arrived more often at night (70.8%) despite an even distribution of transfer requests. The lack of transfer imaging did not affect length of stay, intervention times, or patient outcomes. Daytime arrivals had shorter total transfer time, but longer intenstive care unit and overall length of stay (8.7 and 11.6 days, respectively), worse modified Rankin Scale scores, lower rates of functional independence, and almost twice the mortality rate. Weekend admissions had significantly worse modified Rankin Scale scores and lower rates of functional independence.
  
  
  CONCLUSIONS
  The timing of transfer arrivals, both by hour or day of the week, is correlated with the time to intervention, hospital course, and overall patient outcomes. Patients admitted during the weekend suffered worse functional outcomes and a trend towards increased mortality. While transfer logistics clearly impact patient outcomes, further work is needed to understand these complex relationships.
authors.affiliation: Department of Neurological Surgery, Emory University, Atlanta, Georgia.|Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: Lovasik
authors.affiliation: Department of Neurological Surgery, Emory University, Atlanta, Georgia.|Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Howard
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Evan W
authors.initials: EW
authors.lastname: McClure
authors.affiliation: Department of Neurological Surgery, Emory University, Atlanta, Georgia.|Emory University School of Medicine, Atlanta, Georgia.|Department of Neurology, Emory University, Atlanta, Georgia.
authors.forename: Owen B
authors.initials: OB
authors.lastname: Samuels
authors.affiliation: Department of Neurological Surgery, Emory University, Atlanta, Georgia.|Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Barrow
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019635:Neurosurgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hospital referral; Neurological emergency; Neurosurgery; Resource utilization; Stroke management; Telemedicine; Telemedicine transfer; Transfer