Assessing the Hazards and Benefits of Interhospital Transfers: Urging Informed Decision-Making in Health Care Leadership
There is little research highlighting the implications of interhospital transfers and how business leaders can support them to ensure the highest quality of care for patients. In a study published in Alzheimer’s and Dementia, researchers investigate the impact of interhospital transfers on older adults, specifically focusing on those with Alzheimer's disease and related dementias (ADRD). Over 100,000 older adults aged 65 and above are transferred to different hospitals yearly after an initial emergency department (ED) encounter. The decision to transfer is made by ED physicians when they believe the patient's needs cannot be met in the current setting, such as requiring intensive care or specialty consultation. The research involved a retrospective review of electronic medical records for older adults transferred to a tertiary care hospital between October 2020 and February 2021. Data collected included demographics, insurance type, code status, intensive care, length of stay, specialist consult, procedures within 48 hours, and discharge disposition. The study found that patients with ADRD were less likely to be full code at admission or discharged home. While they received geriatrics or palliative care consults more often, they were less likely to receive intensive care or a procedure within 48 hours of transfer. The odds of not receiving intensive care or a procedure within 48 hours were higher for patients with ADRD.
The authors highlight the need for more scientific knowledge regarding optimal interhospital transfers, leading to a lack of evidence-based care. Patients with ADRD, who visit the ED more frequently than those with other conditions, are particularly vulnerable during transitions of care. The study suggests that an evidence-based approach is needed to determine the impact of interhospital transfers, especially for patients with ADRD.
The findings indicate that the potential harms of interhospital transfer, including increased costs, longer travel times, and separation from home support networks, must be carefully considered. Despite the overall goal of specialized procedures and surgeries to improve outcomes, the study reveals that these interventions occur infrequently, raising questions about the necessity of transfers in many cases. The study suggests alternative approaches, such as telehealth consultations with specialists, may offer equivalent or superior patient-centered care.
"In a population of patients ≥65 years of age transferred to a single tertiary care center from external EDs, ADRD was associated with a lower likelihood of receiving a specialized procedure or ICU admission within the first 48 hours. ," said researchers.
Health care leaders need to understand the risks and benefits of interhospital transfers for patients with ADRD. Researchers hope this study will pave the way for further studies to comprehensively explore outcomes after interhospital transfers, allowing patients and their families to make informed decisions aligned with their goals and values.
Reference
Glober N, LaShell AK, Montelauro N, et al. Impact of interhospital transfer on patients with Alzheimer’s disease and other related dementias. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. 2023;15(3). doi:10.1002/dad2.12469
