Potentially avoidable inter-hospital transfer for gynaecology consultation at a tertiary care centre: a retrospective study. (17th February 2019)

• Record Type: Journal Article
• Authors: Mercier, Rebecca J.; Birnbaum, Sandra
• Is Part Of: Journal of obstetrics and gynaecology. Volume 39:Number 2(2019)
• Page Start: 164
• Page End: 169
• Publication Date: 2019-02-17
• Subjects: Gynaecology -- transfer -- telemedicine -- pregnancy of unknown location -- spontaneous abortion; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618.05
• DOI: 10.1080/01443615.2018.1468742
• Languages: English
• ISSNs: 0144-3615

Abstract

Abstract: Inter-hospital transfers for consultation are common and costly in the USA. Our objective was to evaluate the inter-hospital transfers between the emergency departments (ED) for a gynaecology consultation and to identify markers for potentially avoidable transfers. We performed a retrospective chart review of all transfers accepted by a tertiary care hospital gynaecology service via the ED over two years. Our primary outcome was the designation of the transfer as 'potentially avoidable', defined as a patient discharged home directly from the ED, with no workup or treatment prior to their discharge. The Chi-square tests were used to assess what patient characteristics and medical diagnoses are associated with potentially avoidable transfers. Of 156 patients meeting the inclusion criteria, a total of 38 (24.4%) were potentially avoidable transfers. Women with potentially avoidable transfers were more likely to be pregnant than those whose transfers were necessary (63.2% vs. 40.7% p = .02), and more likely to specifically have a pregnancy of unknown location (PUL) or a complete abortion ( p < .01). Impact statement: What is already known on this subject? In the USA, the emergency department is a common site for the evaluation of women with primary gynaecologic complaints. Many hospitals lack a specialist consultation, and obtaining a consultation may require the inter-hospital transfer of patients. Inter-hospital transfers overall cost more than a billion US dollars per year, and the gynaecologic care of women may account for a significant portion of this cost. There is scant data describing the most common diagnoses that lead to the transfer of women with gynaecologic complaints; a better understanding of the patterns in this area could assist in designing more cost-effective and convenient models of care. What do the results of this study add? Our study confirms the pre-existing clinical impression, which previously had not been quantified, that many women who are transferred for gynaecologic consultation are stable, and these transfers may be avoidable. We demonstrate that women with a pregnancy of an unknown location and with a complete abortion are frequent candidates for avoiding a transfer. What are the implications of these findings for clinical practice and/or future research? Providers should feel confident in considering a remote or telemedicine consultation for women seeking care in the ED for these common conditions. Future research may focus on the longitudinal follow-up of such systems to demonstrate the patient safety outcomes and patient and provider satisfactions.