Transferring general medicine patients from Duke Hospital to Durham Regional Hospital to address hospital bed capacity

Transferring general medicine patients from Duke Hospital to Durham Regional Hospital to address hospital bed capacity

David Gallagher MD, Duke University

Background: Hospital and emergency department overcrowding can affect the quality and safety of care delivered to patients. As one solution to overcrowding and patient throughput, hospitalists at Duke University Hospital (DUH) developed an inter-facility “reverse” transfer process where stable general medicine patients who met predetermined criteria could be directly admitted from the Duke ED to the affiliated Duke community hospital - Durham Regional Hospital (DRH).

Methods: Since 2009, patients who presented to DUH ED were screened for appropriateness of inter-facility transfer and admission to DRH. Criteria for patient selection and a transfer process were developed. If a patient met criteria for transfer and agreed to the transfer they were directly admitted to DRH medicine units from the Duke ED. DUH Hospitalists did all of the admission work in the Duke ED using DRH systems; computerized physician order entry, medication reconciliation, and dictation systems. The patient’s were transferred by ambulance. The physician admitting work was done entirely by the “sending” hospitalist at Duke. We received IRB approval to get demographic and clinical data of our initial experience with this direct admission process.

Results: Prior to August 2010 we have transferred 44 patients using this protocol. Demographics of patients transferred: average age 58.7 years, 54.5 % female, 45.5% male, 54.5% white, 38.6% black, 6.8% asian or hispanic. Length of stay for these patients was 3.9 days (CMA LOS 3.57 days), Case Mix Index 1.09, Readmission within 30 days 13.6%, 79.5% discharged to home (21.5% to other facilities), 2 patients died in their hospitalization after transfer to DRH (4.5% in-hospital mortality). Review of the deaths showed these deaths were not unexpected . The primary patient diagnoses were representative of general internal medicine.

Conclusions: Interfacility transfer and direct admission of stable general medicine patients from a tertiary academic emergency department to a community hospital can help with hospital bed capacity. With a structured protocol in place the outcomes of the patients admitted in this fashion are similar to the standard admission processes.