Kenneth Wong1, Richard D Levy. 1. John Hunter Hospital, Newcastle, New South Wales, Australia. kennethwo@yahoo.com
Abstract
OBJECTIVE: To review mortality associated with interhospital transfers of patients with surgical emergencies from rural and peripheral metropolitan areas. DESIGN: A retrospective case note review. SETTING: All hospitals within an area health service including metropolitan and rural hospitals. SUBJECTS: All patients with a surgical emergency who died in hospital after interhospital transfer within an area health service. MAIN OUTCOME MEASURES: Factors associated with death and interhospital transfer. RESULTS: In total, 22 patients were identified. The mean age was 77 years. Thirty-six per cent of patients were assessed by a surgeon prior to transfer. The mean time taken for transfer was five hours. Ten patients were physiologically unstable prior to transfer. No medical escort accompanied these patients. Four patients deteriorated during the transport process. Seventy-three per cent of patients arrived out of normal working hours. Fifty per cent of patients required an operation within 24 hours of arrival. All of these patients had significant medical co-morbidities. Seventy-two per cent of these operations were performed out of hours as an emergency case. Twenty-three per cent did not receive any operative intervention or intensive care admission at the tertiary referral centre. Forty-one per cent of deaths were related to peritonitis and intra-abdominal soiling. CONCLUSIONS: Hospital systemic issues associated with mortality included extensive time delays in transfers, an inadequate transport process and frequent out-of-hours emergency operations. Patient features related to mortality included advanced age, significant medical co-morbidity and surgical pathology with a poor prognosis. Improvements concerning interhospital transfers of patients should address both systemic and patient issues.
OBJECTIVE: To review mortality associated with interhospital transfers of patients with surgical emergencies from rural and peripheral metropolitan areas. DESIGN: A retrospective case note review. SETTING: All hospitals within an area health service including metropolitan and rural hospitals. SUBJECTS: All patients with a surgical emergency who died in hospital after interhospital transfer within an area health service. MAIN OUTCOME MEASURES: Factors associated with death and interhospital transfer. RESULTS: In total, 22 patients were identified. The mean age was 77 years. Thirty-six per cent of patients were assessed by a surgeon prior to transfer. The mean time taken for transfer was five hours. Ten patients were physiologically unstable prior to transfer. No medical escort accompanied these patients. Four patients deteriorated during the transport process. Seventy-three per cent of patients arrived out of normal working hours. Fifty per cent of patients required an operation within 24 hours of arrival. All of these patients had significant medical co-morbidities. Seventy-two per cent of these operations were performed out of hours as an emergency case. Twenty-three per cent did not receive any operative intervention or intensive care admission at the tertiary referral centre. Forty-one per cent of deaths were related to peritonitis and intra-abdominal soiling. CONCLUSIONS: Hospital systemic issues associated with mortality included extensive time delays in transfers, an inadequate transport process and frequent out-of-hours emergency operations. Patient features related to mortality included advanced age, significant medical co-morbidity and surgical pathology with a poor prognosis. Improvements concerning interhospital transfers of patients should address both systemic and patient issues.