Matthew W Mell1, Peter A Schneider2, Benjamin W Starnes3. 1. Division of Vascular Surgery, Stanford University, Stanford, Calif. Electronic address: mwmell@stanford.edu. 2. Division of Vascular Therapy, Hawaii Permanente Medical Group and Kaiser Foundation Hospital, Honolulu, Hawaii. 3. Division of Vascular Surgery, University of Washington, Seattle, Wash.
Abstract
BACKGROUND: No standards exist for interhospital transfer of patients with ruptured abdominal aortic aneurysm (rAAA). As such, many facilities have developed individual approaches to transfer of these patients. The purpose of this study was to investigate areas of agreement and discord for transfer and to determine if current practices may serve as a starting point for developing universal transfer guidelines. METHODS: A survey was prepared regarding requirements for transfer, factors regarding transport, and available resources at the accepting hospital. The survey was then offered to members of the Western Vascular Society. Responses were analyzed by physician practice type. Consensus was defined as at least 70% agreement for a response. RESULTS: Response rate was 40%. The cohort comprised 51% from academic institutions and 94% from metropolitan areas. Patients with rAAA were accepted in transfer by 88% of respondents; a majority accepted transfers from distances of up to 100 miles or more. Most had no formal protocol for transfer or treatment of patients with rAAA. Wide variation was observed regarding local evaluation, clinical status at presentation, pre-existing medical comorbidity and required tests for determining suitability for transfer, and management during transport. Academic physicians were more likely to accept clinically unstable patients and to have capability to offer endovascular aneurysm repair. CONCLUSIONS: Wide variation was observed regarding clinical suitability for transfer, diagnostic criteria and tests before transfer, and essential resources required at the receiving hospital. Reducing existing variation and inefficiencies in the transfer process by developing standard guidelines may improve population-based outcomes for rAAA.
BACKGROUND: No standards exist for interhospital transfer of patients with ruptured abdominal aortic aneurysm (rAAA). As such, many facilities have developed individual approaches to transfer of these patients. The purpose of this study was to investigate areas of agreement and discord for transfer and to determine if current practices may serve as a starting point for developing universal transfer guidelines. METHODS: A survey was prepared regarding requirements for transfer, factors regarding transport, and available resources at the accepting hospital. The survey was then offered to members of the Western Vascular Society. Responses were analyzed by physician practice type. Consensus was defined as at least 70% agreement for a response. RESULTS: Response rate was 40%. The cohort comprised 51% from academic institutions and 94% from metropolitan areas. Patients with rAAA were accepted in transfer by 88% of respondents; a majority accepted transfers from distances of up to 100 miles or more. Most had no formal protocol for transfer or treatment of patients with rAAA. Wide variation was observed regarding local evaluation, clinical status at presentation, pre-existing medical comorbidity and required tests for determining suitability for transfer, and management during transport. Academic physicians were more likely to accept clinically unstable patients and to have capability to offer endovascular aneurysm repair. CONCLUSIONS: Wide variation was observed regarding clinical suitability for transfer, diagnostic criteria and tests before transfer, and essential resources required at the receiving hospital. Reducing existing variation and inefficiencies in the transfer process by developing standard guidelines may improve population-based outcomes for rAAA.
Authors: Priya B Patel; Christina L Marcaccio; Livia E V M de Guerre; Virendra I Patel; Grace Wang; Kristina Giles; Marc L Schermerhorn Journal: J Vasc Surg Date: 2021-10-13 Impact factor: 4.268
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