Critical care transport: Outcome evaluation after interfacility transfer and hospitalization

Study objective: To test the hypothesis that interfacility transfer is not associated with increased mortality, duration of stay, or readmission withi n 7 days. Methods: We matched 3,298 patients who were hospitalized for chest pain or related complaints in Kaiser Permanente medical centers after transfer from the emergency department of a non-plan hospital (transported patients) wit h 3,298 patients of the same gender and age (+/-5 years) and with the same principal diagnosis who were hospitalized within 6 months without transfer in the same Kaiser Permanente medical center (directly admitted patients). Patients were compared in terms of outcome measures: in-hospital deaths, co ntinued care in another facility, readmission within 7 days, in-patient len gth of stay (LOS), and LOS in special care units. Results: The adjusted odds ratios for in-hospital mortality and readmission within 7 days were 1.0 (95% confidence interval, .8 to 1.4) and .9 (95% co nfidence interval, .7 to 1.2), respectively. The adjusted mean difference i n LOS was -.1 days (95% confidence interval, -.2 to .1). Transported and di rectly admitted cardiac patients were also compared for all examined outcom e measures at each of 10 medical centers. At a few medical centers, we obse rved significant difference in LOS, special care LOS, and continued care in another facility. However, all these differences were small, and most were probably random errors. Conclusion: Conservative patient selection criteria, pretransfer stabilizat ion, and the use of appropriate equipment and medical personnel have result ed in the interfacility transfer program's achieving its goal of transferri ng high-risk patients without adverse impact on clinical outcomes or resour ce use.