Survival of patients transferred to tertiary intensive care from rural community hospitals

Background: Accessibility to tertiary intensive care resources differs amon g hospitals within a rural region. Determining whether accessibility is ass ociated with outcome is important for understanding the role of regionaliza tion when providing critical care to a rural population. Methods: In a prospective design, we identified and recorded the mortality ratio, percentage of unanticipated deaths, length of stay in the intensive care unit (ICU), and survival time of 147 patients transferred directly fro m other hospitals and 178 transferred from the wards within a rural tertiar y-care hospital. Results: The two groups did not differ significantly in the characteristics measured. Differences in access to tertiary critical care in this rural re gion did not affect survival or length of stay after admission to this tert iary ICU. The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mort ality associated with transfer from a rural community hospital was not stat istically significant. Conclusions: Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who de velop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services.