Volume 92, Issue 6 pp. 1322-1331

SPECIAL ARTICLE

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Edward Young MBBS,

Corresponding Author

Edward Young MBBS

[email protected]

orcid.org/0000-0002-5262-5200

The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia

Correspondence

Dr Edward Young, The University of Adelaide, Faculty of Health and Medical Sciences, PO Box 328, Torrensville, South Australia, 5031, Australia.

Email: [email protected]

Contribution: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing - original draft, Writing - review & editing

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Helena S. Kopunic BSc (Hons), MRes, MEd, PhD,

Helena S. Kopunic BSc (Hons), MRes, MEd, PhD

Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia

Contribution: Data curation, Methodology, Resources, Writing - review & editing

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Markus I. Trochsler MD, MMIS, FMH, FRACS,

Markus I. Trochsler MD, MMIS, FMH, FRACS

orcid.org/0000-0002-0650-9153

The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

Contribution: Formal analysis, Methodology, Supervision, Validation, Writing - review & editing

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Guy J. Maddern PhD, FRACS,

Guy J. Maddern PhD, FRACS

orcid.org/0000-0003-2064-181X

The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia

Contribution: Conceptualization, Data curation, Methodology, Supervision, Validation, Writing - review & editing

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Edward Young MBBS,

Corresponding Author

Edward Young MBBS

[email protected]

orcid.org/0000-0002-5262-5200

The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia

Correspondence

Dr Edward Young, The University of Adelaide, Faculty of Health and Medical Sciences, PO Box 328, Torrensville, South Australia, 5031, Australia.

Email: [email protected]

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Helena S. Kopunic BSc (Hons), MRes, MEd, PhD,

Helena S. Kopunic BSc (Hons), MRes, MEd, PhD

Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia

Contribution: Data curation, Methodology, Resources, Writing - review & editing

Search for more papers by this author

Markus I. Trochsler MD, MMIS, FMH, FRACS,

Markus I. Trochsler MD, MMIS, FMH, FRACS

orcid.org/0000-0002-0650-9153

The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

Contribution: Formal analysis, Methodology, Supervision, Validation, Writing - review & editing

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Guy J. Maddern PhD, FRACS,

Guy J. Maddern PhD, FRACS

orcid.org/0000-0003-2064-181X

The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia

Australian and New Zealand Audit of Surgical Mortality (ANZASM), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia

Contribution: Conceptualization, Data curation, Methodology, Supervision, Validation, Writing - review & editing

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First published: 03 April 2022

https://doi.org/10.1111/ans.17669

Citations: 4

E. Young MBBS; H. S. Kopunic BSc (Hons), MRes, MEd, PhD; M. I. Trochsler MD, MMIS, FMH, FRACS; G. J. Maddern PhD, FRACS.

This paper is not based on any previous communications to a society or meeting. All authors had full access to all data, tables and statistical reports.

Funding information: The first author is a recipient of the Australian Government Research Training Program Scholarship.

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Abstract

Background

Interhospital transfers in Australia facilitate access to acute surgical services, however transfer delays can occur. The aims of this study were to examine Australian mortality audit data on acute surgical patients who were transferred after presenting with a surgical emergency, and to identify modifiable predictors of transfer delay.

Methods

Surgical admissions between 1 January 2001 and 18 August 2020 were retrospectively extracted from the Australian and New Zealand Audit of Surgical Mortality database. Relevant factors and themes of interest were collated. Results were presented as odds ratios (OR) and 95% confidence intervals (CI), with statistical significance defined as P <0.05.

Results

After exclusion, a final 8270 cases were analysed. Non-modifiable predictors identified were female gender (OR 1.34, 95% CI 1.05–1.70, P = 0.0184), comorbidities (OR 1.50, 95% CI 1.40–161, P <0.0001) and major non-trauma non-vascular specialty (OR 1.54 to 7.77, depending on specialty, P < 0.05). Modifiable predictors were inadequate clinical assessment (OR 49.48, 95% CI 32.91–74.38, P <0.0001), poor communication (OR 6.62, 95% CI 3.70–11.85, P <0.0001) and multiple transfers (OR 6.30, OR 95% 4.31–9.21, P <0.0001). Age, lack of bed and after-hours transfer did not predict transfer delays. Metropolitan transfers was protective against transfer delays (OR 0.64, 95% CI 0.47–0.86, P = 0.0035).

Conclusion

In the view of the receiving surgeon or assessor, all transfer delays potentially contributed to patient deaths, and may have been preventable. Strategies directed at modifiable factors could minimize delays. Increased surgical services in non-metropolitan regions could reduce need for transfer. Prospective data is required to examine if the same predictors are observed in surgical patients who survive.

Conflict of interest

None declared.

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Volume92, Issue6

June 2022

Pages 1322-1331

Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Abstract

Background

Methods

Results

Conclusion

Conflict of interest

References

Citing Literature

References

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Predictors of interhospital transfer delays in acute surgical patient deaths in Australia: a retrospective study

Abstract

Background

Methods

Results

Conclusion

Conflict of interest

References

Citing Literature

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