Interhospital transfer for acute surgical care: does delay matter?

Am J Surg. 2016 Nov;212(5):823-830. doi: 10.1016/j.amjsurg.2016.03.004. Epub 2016 Jun 1.


Background: Delays to definitive care are associated with poor outcomes after trauma and medical emergencies. It is unknown whether inter-hospital transfer delays affect outcomes for nontraumatic acute surgical conditions.

Methods: We performed a retrospective cohort study of patient transfers for acute surgical conditions within a regional transfer network from 2009 to 2013. Delay was defined as more than 24 hours from presentation to transfer request and categorized as 1 or 2+ days. The primary outcome was post-transfer death or hospice. Bivariate and multivariable logistic regression were performed.

Results: The cohort included 2,091 patient transfers. Delays of 2 or more days were associated with death or hospice in unadjusted analyses, but there was no difference after adjustment. Predictors of post-transfer death or hospice included older age, higher comorbidity scores, and greater severity of illness.

Conclusions: Delays in transfer request were not associated with post-transfer mortality or discharge to hospice, suggesting effective triage of nontraumatic acute surgical patients.

Keywords: Acute care surgery; Death; Delay; Hospice; Inter-hospital; Quality; Transfer.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Age Factors
  • Aged
  • Cohort Studies
  • Emergency Service, Hospital / trends*
  • Female
  • Hospital Mortality*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Safety
  • Patient Selection
  • Patient Transfer / statistics & numerical data*
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Surgical Procedures, Operative / methods
  • Surgical Procedures, Operative / mortality*
  • Tertiary Care Centers