Inter-hospital transfers from rural hospitals to an academic medical center.

INTRODUCTION: The need for inter-hospital patient transfers from rural hospitals, especially Critical Access Hospitals, to larger, more urban hospitals is predictable considering the limited resources at rural hospitals. No systematic study of the inter-hospital transfers themselves has been published. The aim of this retrospective descriptive chart review was to provide a preliminary look at inter-hospital transfers from rural hospitals to a more urban, academic medical center in West Virginia. Ultimately, the creation of an agenda for further research was in view.
METHODS: A list of study participants was generated from the academic center's electronic health record database. Study participants were patients who had been transferred for acute care, from November 2011 through June 2012, to the receiving hospital from another acute care hospital and had been under the care of the family medicine teaching service.
RESULTS: One hundred and thirty-eight patient transfers were included. Medicare was the most common source of health insurance coverage but over a third of the patients were uninsured. Only five of the twenty-four referring hospitals were Critical Access Hospitals. Four institutions alone initiated 49.3% of transfers. Nineteen specialty services were sought with critical care and neurology accounting for 53.9% of requests. Stroke or stroke-like presentation was the most common transfer diagnosis. 24.6% of transfers were transferred for services that were available at the transferring facility.
CONCLUSIONS: This study has suggested an agenda for further research that includes replication and analysis of the data with larger study samples as well as qualitative research into the transferring physicians' decision-making process.