Patient and Hospital Characteristics Associated With the Interhospital Transfer of Adult Patients With Sepsis

Uchenna R Ofoma; Tierney J Lanter; Elena Deych; Marin Kollef; Fei Wan; Karen E Joynt Maddox

doi:10.1097/CCE.0000000000001009

Patient and Hospital Characteristics Associated With the Interhospital Transfer of Adult Patients With Sepsis

Crit Care Explor. 2023 Nov 29;5(12):e1009. doi: 10.1097/CCE.0000000000001009. eCollection 2023 Dec.

Authors

Uchenna R Ofoma¹, Tierney J Lanter², Elena Deych², Marin Kollef³, Fei Wan⁴, Karen E Joynt Maddox^{2

5}

Affiliations

¹ Division of Critical Care Medicine, Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.
² Division of Cardiology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
⁴ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
⁵ Center for Advancing Health Services, Policy and Economics Research, Washington University Institute of Public Health, St. Louis, MO.

Abstract

Importance: The interhospital transfer (IHT) of patients with sepsis to higher-capability hospitals may improve outcomes. Little is known about patient and hospital factors associated with sepsis IHT.

Objectives: We evaluated patterns of hospitalization and IHT and determined patient and hospital factors associated with the IHT of adult patients with sepsis.

Design: Retrospective cohort study.

Setting and participants: A total of 349,938 adult patients with sepsis at 329 nonfederal hospitals in California, 2018-2019.

Main outcomes and measures: We evaluated patterns of admission and outward IHT between low sepsis-, intermediate sepsis-, and high sepsis-capability hospitals. We estimated odds of IHT using generalized estimating equations logistic regression with bootstrap stepwise variable selection.

Results: Among the cohort, 223,202 (66.4%) were initially hospitalized at high-capability hospitals and 10,870 (3.1%) underwent IHT. Nearly all transfers (98.2%) from low-capability hospitals were received at higher-capability hospitals. Younger age (< 65 yr) (adjusted odds ratio [aOR] 1.54; 95% CI, 1.40-1.69) and increasing organ dysfunction (aOR 1.22; 95% CI, 1.19-1.25) were associated with higher IHT odds, as were admission to low-capability (aOR 2.79; 95% CI, 2.33-3.35) or public hospitals (aOR 1.35; 95% CI, 1.09-1.66). Female sex (aOR 0.88; 95% CI, 0.84-0.91), Medicaid insurance (aOR 0.59; 95% CI, 0.53-0.66), home to admitting hospital distance less than or equal to 10 miles (aOR 0.92; 95% CI, 0.87-0.97) and do-not-resuscitate orders (aOR 0.48; 95% CI, 0.45-0.52) were associated with lower IHT odds, as was admission to a teaching hospital (aOR 0.83; 95% CI, 0.72-0.96).

Conclusions and relevance: Most patients with sepsis are initially hospitalized at high-capability hospitals. The IHT rate for sepsis is low and more likely to originate from low-capability and public hospitals than from high-capability and for-profit hospitals. Transferred patients with sepsis are more likely to be younger, male, sicker, with private medical insurance, and less likely to have care limitation orders. Future studies should evaluate the comparative benefits of IHT from low-capability hospitals.

Keywords: hospital capability; patient transfer; regionalization; rural hospitals; sepsis.

Abstract

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