Community hospital transfers to a VA Medical Center.

We prospectively studied all transfers from community hospitals to the Zablocki Veterans Administration Medical Center in Milwaukee (Wis) between May 28, 1986, and January 1, 1987. Transfers totaled 4.7% (311/6609) of acute-care admissions during the study period but accounted for 19.1% (39/204) of in-hospital deaths. The mortality rate for transferred patients who required Veterans Administration hospitalization was 12.5% (39/311) compared with 2.6% (165/6298) for all other admissions. At the time of transfer 59 patients (19%) were judged unstable by a modification of the APACHE II classification system, yet only 19 patients were cared for en route by a physician or a nurse. In addition to higher mortality, the transferred patients had a longer median length of stay than nontransferred patients (11 days vs 7 days).