Proactive review by the emergency department before inter-hospital transfer (the PREVENT study)

Biswadev Mitra, Annie Carter, De Villiers Smit, Fatima Rahman, Shane O'Donovan, Alexander Olaussen, Jiun Kae Pui, Jeremy Abetz, Peter Hunter, Peter A. Cameron

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Objectives: To determine the population of patients where patient transfer may be prevented by assessment of a senior ED registrar at the referring hospital. Methods: Patients transferred from Caulfield Hospital, specialising in community services, rehabilitation, aged care and aged mental health to The Alfred Emergency and Trauma Centre, an adult major referral centre within the same clinical network were identified from 1 July 2016 to 31 December 2016. Medical records were reviewed independently by two clinicians to determine preventability of transfer and whether attendance by a senior ED registrar could have prevented the transfer. Results: There were 221 patients included with a mean age of 73.6(15.1) years. The median time spent in the ED was 4 h (interquartile range 2–8) and 197 (89.1%) were admitted. There were 107 (48.6%) transfers deemed preventable or potentially preventable, with 104 preventable by attendance of a senior ED registrar. The most common indication for transfer was acute trauma (n = 55; 24.9%), and the odds of a case being preventable or potentially preventable if transferred for the primary indication of trauma was 3.9 (95% confidence interval 2.1–7.1; P < 0.001). Among the preventable cases, the total cost of transfer was AU$105 984 over 6 months, not accounting for the costs of duplication of care. Conclusions: This proof-of-concept study suggests that strategies to expand the provision of acute care to outreach within specialist networks and reduce patient transfers should be further explored. An outreach programme for improved acute assessment of patients at the referring hospital particularly after acute trauma may prevent transfers, improving care pathways.

Original languageEnglish
Number of pages6
JournalEMA - Emergency Medicine Australasia
DOIs
Publication statusAccepted/In press - Jul 2019

Keywords

  • aged care
  • emergency
  • transfers
  • wounds and injuries

Cite this

@article{4f556ed4f7374bd4a02024dea5b9de3c,
title = "Proactive review by the emergency department before inter-hospital transfer (the PREVENT study)",
abstract = "Objectives: To determine the population of patients where patient transfer may be prevented by assessment of a senior ED registrar at the referring hospital. Methods: Patients transferred from Caulfield Hospital, specialising in community services, rehabilitation, aged care and aged mental health to The Alfred Emergency and Trauma Centre, an adult major referral centre within the same clinical network were identified from 1 July 2016 to 31 December 2016. Medical records were reviewed independently by two clinicians to determine preventability of transfer and whether attendance by a senior ED registrar could have prevented the transfer. Results: There were 221 patients included with a mean age of 73.6(15.1) years. The median time spent in the ED was 4 h (interquartile range 2–8) and 197 (89.1{\%}) were admitted. There were 107 (48.6{\%}) transfers deemed preventable or potentially preventable, with 104 preventable by attendance of a senior ED registrar. The most common indication for transfer was acute trauma (n = 55; 24.9{\%}), and the odds of a case being preventable or potentially preventable if transferred for the primary indication of trauma was 3.9 (95{\%} confidence interval 2.1–7.1; P < 0.001). Among the preventable cases, the total cost of transfer was AU$105 984 over 6 months, not accounting for the costs of duplication of care. Conclusions: This proof-of-concept study suggests that strategies to expand the provision of acute care to outreach within specialist networks and reduce patient transfers should be further explored. An outreach programme for improved acute assessment of patients at the referring hospital particularly after acute trauma may prevent transfers, improving care pathways.",
keywords = "aged care, emergency, transfers, wounds and injuries",
author = "Biswadev Mitra and Annie Carter and Smit, {De Villiers} and Fatima Rahman and Shane O'Donovan and Alexander Olaussen and Pui, {Jiun Kae} and Jeremy Abetz and Peter Hunter and Cameron, {Peter A.}",
year = "2019",
month = "7",
doi = "10.1111/1742-6723.13338",
language = "English",
journal = "EMA - Emergency Medicine Australasia",
issn = "1742-6731",
publisher = "Wiley-Blackwell",

}

Proactive review by the emergency department before inter-hospital transfer (the PREVENT study). / Mitra, Biswadev; Carter, Annie; Smit, De Villiers; Rahman, Fatima; O'Donovan, Shane; Olaussen, Alexander; Pui, Jiun Kae; Abetz, Jeremy; Hunter, Peter; Cameron, Peter A.

In: EMA - Emergency Medicine Australasia, 07.2019.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Proactive review by the emergency department before inter-hospital transfer (the PREVENT study)

AU - Mitra, Biswadev

AU - Carter, Annie

AU - Smit, De Villiers

AU - Rahman, Fatima

AU - O'Donovan, Shane

AU - Olaussen, Alexander

AU - Pui, Jiun Kae

AU - Abetz, Jeremy

AU - Hunter, Peter

AU - Cameron, Peter A.

PY - 2019/7

Y1 - 2019/7

N2 - Objectives: To determine the population of patients where patient transfer may be prevented by assessment of a senior ED registrar at the referring hospital. Methods: Patients transferred from Caulfield Hospital, specialising in community services, rehabilitation, aged care and aged mental health to The Alfred Emergency and Trauma Centre, an adult major referral centre within the same clinical network were identified from 1 July 2016 to 31 December 2016. Medical records were reviewed independently by two clinicians to determine preventability of transfer and whether attendance by a senior ED registrar could have prevented the transfer. Results: There were 221 patients included with a mean age of 73.6(15.1) years. The median time spent in the ED was 4 h (interquartile range 2–8) and 197 (89.1%) were admitted. There were 107 (48.6%) transfers deemed preventable or potentially preventable, with 104 preventable by attendance of a senior ED registrar. The most common indication for transfer was acute trauma (n = 55; 24.9%), and the odds of a case being preventable or potentially preventable if transferred for the primary indication of trauma was 3.9 (95% confidence interval 2.1–7.1; P < 0.001). Among the preventable cases, the total cost of transfer was AU$105 984 over 6 months, not accounting for the costs of duplication of care. Conclusions: This proof-of-concept study suggests that strategies to expand the provision of acute care to outreach within specialist networks and reduce patient transfers should be further explored. An outreach programme for improved acute assessment of patients at the referring hospital particularly after acute trauma may prevent transfers, improving care pathways.

AB - Objectives: To determine the population of patients where patient transfer may be prevented by assessment of a senior ED registrar at the referring hospital. Methods: Patients transferred from Caulfield Hospital, specialising in community services, rehabilitation, aged care and aged mental health to The Alfred Emergency and Trauma Centre, an adult major referral centre within the same clinical network were identified from 1 July 2016 to 31 December 2016. Medical records were reviewed independently by two clinicians to determine preventability of transfer and whether attendance by a senior ED registrar could have prevented the transfer. Results: There were 221 patients included with a mean age of 73.6(15.1) years. The median time spent in the ED was 4 h (interquartile range 2–8) and 197 (89.1%) were admitted. There were 107 (48.6%) transfers deemed preventable or potentially preventable, with 104 preventable by attendance of a senior ED registrar. The most common indication for transfer was acute trauma (n = 55; 24.9%), and the odds of a case being preventable or potentially preventable if transferred for the primary indication of trauma was 3.9 (95% confidence interval 2.1–7.1; P < 0.001). Among the preventable cases, the total cost of transfer was AU$105 984 over 6 months, not accounting for the costs of duplication of care. Conclusions: This proof-of-concept study suggests that strategies to expand the provision of acute care to outreach within specialist networks and reduce patient transfers should be further explored. An outreach programme for improved acute assessment of patients at the referring hospital particularly after acute trauma may prevent transfers, improving care pathways.

KW - aged care

KW - emergency

KW - transfers

KW - wounds and injuries

UR - http://www.scopus.com/inward/record.url?scp=85068659849&partnerID=8YFLogxK

U2 - 10.1111/1742-6723.13338

DO - 10.1111/1742-6723.13338

M3 - Review Article

JO - EMA - Emergency Medicine Australasia

JF - EMA - Emergency Medicine Australasia

SN - 1742-6731

ER -