Transfer Denials Create Barriers to Effective Regionalization of Vascular Care
Andy M. Lee, MD, Elsie G Ross MD, Chelsea A. Dorsey MD, Matthew W. Mell MD, MS.
Stanford Hospital and Clinics, Stanford, CA, USA.
OBJECTIVES: Many tertiary referral hospitals have established centers to facilitate the transfer of patients with emergent or complex vascular conditions for definitive care. We sought to examine the effectiveness of a transfer center for supporting regional vascular care at an academic medical center.
METHODS: We analyzed all vascular transfer requests from January 2011 through July 2015. Accepted transfers were characterized by diagnosis, source of transfer request, and method of transport. Hospital factors contributing to transfer denials were also identified.
RESULTS: We received a total of 714 vascular transfer requests. Transfer requests originated from an emergency department in 59% and from in-patient units in 41%. The most common diagnoses for transfers were aortic pathology (31%) and peripheral vascular disease (27%). Of requests, 243 (34%) were ultimately accepted, with 71% transferred by ground and 29% transferred by air. Receiving departments included ICU or telemetry (76%), OR (4%), surgical ward (14%) and Emergency Department (7%). Transfer requests were denied for 320 (45%) patients. Reasons for denial included no bed availability (74%), denied insurance authorization (5%), death prior to transfer (2%), and non-vascular diagnosis (19%). Requesting facilities were compelled to secure transfer to another facility for 22% of capacity-related denials while waiting for our hospital to produce bed availability. Transfer was not required for 151 (21%) patients because telephone advice or outpatient follow-up addressed the condition for which transfer was requested.
CONCLUSIONS: Transfer centers enable a triage interface for patients to receive vascular consultation and care. However, ineffective or absent administrative processes may significantly diminish the effectiveness of a transfer center to facilitate access to vascular services. Regionalization of vascular services is most effective for both sending and receiving facilities when administrative denials are eliminated. Further study is warranted to optimize inter-hospital transfer policies and allocation of hospital resources.
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