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Introduction
Patients presenting to emergency departments with complaints requiring emergency general
surgery (EGS) often require transport to tertiary care because fewer than 50% of hospitals
have EGS services. The need for interfacility transport to tertiary care is associated
with increased hospital length of stay (LOS) and morbidity among medical patients,
however there is limited data available evaluating the cost and impact of transports
among EGS patients. The purpose of this study was to analyze the costs, transport
resource utilization, and outcomes of EGS patients transferred to tertiary care with
acute appendicitis.
Methods
This was an IRB approved retrospective study of adult patients transferred from an
in-network referral ED to a single tertiary care facility between 20 May 2015 & 30
September 2020 who were transferred with diagnosis of appendicitis. Data collected
from the health system's electronic medical record (EMR) included patient demographics,
emergency department and interfacility transport hemodynamics, diagnostic testing
results, timeliness of referral and transport, transport level of care, social determinants
of health, and patient charges. Data was analyzed with R version 1.0.2. Our Primary
Outcome was the hospital length of stay and our secondary outcomes were time from
initial presentation to incision, cost to patient, and transport resource allocation.
Results
A total of 480 adult patients were transferred for tertiary EGS care during the study
period and were included in the final analysis. 89.4% of patients (n=429) received
ambulance transport awhile 10.6% (n=51) were transported via private vehicle. All
patients were discharged home alive. Critical Care Transport (CCT) teams transported
61.5% (n=295) of patients while Advanced Life Support (ALS) teams transported 26.0%
(n=125). Although CCT teams were more likely than ALS teams to establish and maintain
intravenous fluids (54.6% vs 37.6%, p=0.002) there was no difference in analgesia
(36.9% vs 27.4% p=0.078), antiemetic (26.8% vs 20.0% p=0.178), or antibiotic (13.3%
vs 6.4% p=0.062) administration between critical care and ALS providers. No life-saving
interventions were provided by any transport team. Ambulance transport did not shorten
hospital length of stay compared to transport via private vehicle (p=0.67).
Conclusion
In this single center study transport via ambulance did not reduce hospital length
of stay compared to transport via private vehicle and there was no difference in the
care provided between ALS and CCT teams.
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© 2022 Published by Elsevier Inc.
