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An Evaluation Of Emergency General Surgery Transfers And A Call For Standardization Of Practices
*Elizabeth H Bruenderman, *Stacy B Block, *Farid J Kehdy, *Matthew V Benns, Keith R Miller, *Nicholas A Nash, *Matthew C Bozeman, Robert C.G. Martin
University of Louisville, Louisville, KY

Objective: A critical rural workforce shortage has contributed to the regionalization of emergency general surgery (EGS), which burdens patients. The absence of a standardized EGS transfer algorithm creates the potential for unnecessary transfers. The aim of this study was to evaluate the reasons prompting EGS transfers and to initiate a discussion for optimal EGS utilization.
Methods: Consecutive EGS transfers (December 2018 to May 2019) to two tertiary centers were prospectively enrolled in an IRB-approved protocol. Clinical reasoning prompting transfers was obtained prospectively from the accepting/consulting surgeon. Patient outcomes were utilized to create an algorithm for EGS transfer.
Results: Two Hundred EGS transfers (49% admissions, 51% consults) occurred with a median age of 59 (18 to 100) and BMI of 30 (15 to 75). Insurance status was 25% private, 45% Medicare, 21% Medicaid, 9% uninsured. Weekend transfers (Friday to Sunday) occurred in 45%, and 57% occurred overnight (6:00pm to 6:00am). Surgeon-to-surgeon communication occurred with 22% of admissions. Pre-transfer notification occurred with 10% of consults. Common transfer reasons included no surgical coverage (20%), surgeon discomfort (24%), or hospital limitations (36%). A minority (36%) underwent surgery within 24 hours, 54% did not require surgery during the admission. Median length-of-stay was 6 (1 to 44) days.
Conclusion: Conditions prompting EGS transfers are heterogeneous in this rural state review. There remains an unmet need to standardize EGS transfer criteria, incorporating patient and hospital factors and surgeon availability (Figure 1). Well-defined requirements for communication with the accepting surgeon may prevent unnecessary transfers and maximize resource allocation.


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