D. Keeven1, C. Harris1, D. Davenport1, A. Bernard1 1University Of Kentucky,Lexington, KY, USA
Introduction: Emergency general surgery (EGS) patients that require greater resource utilization have worse outcomes compared to trauma patients. Patients from rural areas have poor EGS and trauma outcomes due in part to regionalization of care from community hospitals to tertiary care centers. We hypothesize that patients transferred after inpatient admission at community hospitals are associated with higher healthcare utilization and worse outcomes compared to those who were not.
Methods: Discharge data was collected retrospectively for patients admitted to the acute care surgery service during calendar 2015 for nine common EGS diagnoses (obstruction, appendicitis, pancreatitis, hernia, ischemia, volvulus, diverticular disease, perforation and peritonitis). Patients were grouped by admission source as local patients admitted from our ED, urgent care or primary care clinics (LAs), transferred from an outside ED (EDTs), or transferred from an inpatient unit at another hospital (IPTs). Demographic data, length of stay at originating site, insurance status, and Charlson Comorbidity Index (CCI) were obtained for all patients along with financial outcomes from the finance system.
Results:A total of 352 patients were reviewed: 125 LAs, 176 EDTs, and 51 IPTs. Compared with EDTs and LAs, IPTs were more frequently treated for pancreatitis (26% of cases vs. 10% and 10%) and less frequently for appendicitis (2% of cases vs. 22% and 26%, p = .005). More IPTs were insured by Medicare or Medicaid (92% vs. 81% and 74%, p = .001). IPTs had a longer length of stay, higher direct costs, and a higher case mix index leading to higher revenue, but still averaged a net loss (Table). Inpatient transfers have more comorbidities (CCI 3.20 versus 2.69 and 2.13), were older (60.8 vs. 56.15 and 50.24), and had a higher mortality rate (9.8% vs. 1.7% and 0.8%).
Conclusion:Patients who present to a tertiary care emergency general surgery service as a direct admit from an inpatient ward at another hospital have more comorbidities, a higher mortality rate, require more resources and have a net financial loss compared to those who present directly from the ED. As healthcare shifts to value-based care, development of new approaches to determine optimal timing of transfer is imperative.
