Interhospital Transfer: Transfer Processes and Patient Outcomes
Interhospital Transfer: Transfer Processes and Patient Outcomes
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DOI：
10.12788/jhm.3192
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发表时间：
2019-08-01
影响因子：
2.6
通讯作者：
Schnipper, Jeffrey
中科院分区：
文献类型：
--
作者：
Mueller, Stephanie K.;Fiskio, Julie;Schnipper, Jeffrey
虽然医院间转院(IHT)通常是为患者提供专门的护理，但对于特定的患者来说，IHT与较差的结果相关。有人认为，移交进程的某些方面是促成这些成果的因素。我们进行了一项回顾性队列研究，研究对象包括2005年1月至2013年9月间在三级护理医院接受IHT治疗的18岁患者。我们研究了“周末”转院、“夜间”转院、转院接受和到达之间的“时间延迟”，以及转院当天入院团队的“忙碌”与患者结局之间的关系，包括48小时内转院到重症监护病房(ICU)和30天内的死亡率。我们使用了多变量Logistic回归模型，对患者特征进行了调整。二次分析检查了详细的转院时间，并评估了按转院服务时间分层的30天死亡率。在24,352名接受IHT的患者中，夜间转移与调整后的ICU转移优势(优势比[OR]1.54；95%可信区间1.38，1.72)和30天死亡率(优势比1.16；95%可信区间1.01，1.35)相关。二次分析证实了夜间转移和整个星期的ICU转移之间的联系，并表明与周一白天转移相比，周日(和周五的趋势)夜间转移增加了30天的死亡率。分层分析显示，在心胸外科和胃肠外科服务转移中，转移特征与调整后的30天死亡率之间存在显著的相关性。我们的发现表明，高视力患者在转院的非高峰时间和护理团队工作量高的时候预后更差。需要进一步研究，以找出解释这些联系的根本原因，并制定可能的解决方案。(C)2019年医院医学会
Though often undertaken to provide patients with specialized care, interhospital transfer (IHT) is associated with worse outcomes for select patients. Certain aspects of the transfer process have been suggested as contributors to these outcomes. We performed a retrospective cohort study including patients >= 18 years who underwent IHT to a tertiary care hospital between January 2005 and September 2013. We examined the association between "weekend" transfer, "nighttime" transfer, "time delay" between transfer acceptance and arrival, and admission team "busyness" on the day of transfer, and patient outcomes, including transfer to the intensive care unit (ICU) within 48 hours and 30-day mortality. We utilized multivariable logistic regression models, adjusting for patient characteristics. Secondary analyses examined detailed timing of transfer and evaluated 30-day mortality stratified by service of transfer. Among the 24,352 patients who underwent IHT, the nighttime transfer was associated with increased adjusted odds of ICU transfer (odds ratio [OR] 1.54; 95% CI 1.38, 1.72) and 30-day mortality (OR 1.16; 95% CI 1.01, 1.35). Secondary analyses confirmed the association between nighttime transfer and ICU transfer throughout the week and demonstrated that Sunday (and trend towards Friday) night transfers had increased 30-day mortality, as compared with Monday daytime transfer. Stratified analyses demonstrated a significant association between transfer characteristics and adjusted odds of 30-day mortality among cardiothoracic and gastrointestinal surgical service transfers. Our findings suggest high acuity patients have worse outcomes during off-peak times of transfer and during times of high care team workload. Further study is needed to identify underlying reasons to explain these associations and devise potential solutions. (C) 2019 Society of Hospital Medicine