Author Credentials

Dilip Nair, MD, Freddie Vaughan, MD, Katherine Bennett, MD





Objective: To document the characteristics of acute care patient transfers from rural West Virginia hospitals.

Data Sources/Study Setting: Hospital patient charts in rural West Virginia hospitals

Design: We examined 40 acute care patient transfers from rural West Virginia hospitals for patients’ age, gender, race and primary health insurance, the diagnosis and desired specialty service. We compared patients who were not transferred. For each transfer we collected data on the reason for transfer, the availability of beds of the appropriate acuity level as well as the availability of the relevant specialty at the time of transfer.

Principal Findings: Transferred patients were more likely than non-transferred patients to be younger, severely ill and diagnosed with acute coronary syndrome. The relevant specialist was available at the transferring hospital in 6 out of 30 transfers. Beds were available in all cases.

Conclusions: This pilot study provides an agenda for future research into the decision to transfer patients for acute care from rural hospitals.

Conflict(s) of Interest


References with DOI

1. Kindermann D, Mutter R, Pines JM. Emergency department transfers to acute care facilities HCUP Statistical Brief #155. 2009. Available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb155.pdf [Accessed on July 30, 2016].

2. Handel DA, Sklar DP, Hollander JE et al. Executive Summary: The Institute of Medicine report and the future of academic emergency medicine and Association of Academic Chairs in Emergency Medicine panel: Association of American Medical Colleges Annual Meeting, October 28, 2006. Academic Emergency Medicine 2007;14: 261-267. https://doi.org/10.1197/j.aem.2007.01.011

3. Casey M, McCullough J, Krieger R. University of Minnesota Rural Health Research Center. Which Medicare Patients Are Transferred from Rural Emergency Departments? Policy Brief June 2014. Available at: http://rhrc.umn.edu/2014/06/which-medicare-patients-are-transferred-from-rural-emergencydepartments/ [accessed on July 29, 2016].

4. Nair D, Gibbs MM. Inter-hospital transfers from rural hospitals to an academic medical center. West Virginia Medical Journal.2013;109:44-49.

5. Ward MM, Odutola JJ. Inter-hospital transfers of patients with systemic lupus erythematosus: characteristics, predictors and outcomes. Journal of Rheumatology. 2006; 33(8):1578-1585.

6. Westfall JM, Kiefe CI, Weissman NW et al. Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project. BMC Cardiovascular Disorders. 2008;8:22. doi: 10.1186/1471-2261-8-22. https://doi.org/10.1186/1471-2261-8-22

7. Muus,KJ, Knudson AD, Klug MG, Wynee J. In-hospital mortality among rural medicare patients with acute myocardial infarction: the influence of demographics, transfer, and health factors. Journal of Rural Health.2011; 27(4):394-400. https://doi.org/10.1111/j.1748-0361.2010.00351.x

8. Kudlow P, Burns KEA, Adhikari NKJ, et al. Inter-hospital transfers and outcomes of critically ill patients with severe acute kidney injury: a multicenter cohort study. Critical Care. 2014;18:513.https://doi.org/10.1186/s13054-014-0513-1

9. Seferian EG, Afessa B, Gajic O, Keegan MT, Hubmayr RD. Comparison of community and referral intensive care unit patients in a tertiary medical center: evidence for referral bias in the critically ill. Critical Care Medicine. 2008; 36(10):2779-2786. https://doi.org/10.1097/ccm.0b013e318186ab1b

10. Barratt H, Harrison DA, Rowan KM, Raine R. Effect of non-clinical inter-hospital critical care unit to unit transfer of critically ill patients: a propensity-matched cohort analysis. Critical Care. 2012; 16(5): R179. doi: 10.1186/cc11662. https://doi.org/10.1186/cc11662

11. Basu J. Severity of illness, race, and choice of local versus distant hospitals among the elderly. Journal of Health Care for the Poor and Underserved. 2005;16: 391–405. https://doi.org/10.1353/hpu.2005.0023