Do Emergency Physicians Improve the Appropriateness of Emergency Transfer in Rural Areas?

Abstract

BACKGROUND: Until recently, there have been few studies on the transfer of patients from emergency departments (EDs) overall, as such studies were limited primarily to trauma patients. OBJECTIVES: The purpose of this study was to investigate the association between the specialty of the primary referring physician and the appropriateness of the emergency transfer (AET). METHODS: This was a retrospective, observational study performed at two level-3 EDs in a rural area. A transfer to a higher-level ED for the purpose of patient stabilization was defined as an emergency transfer, and transfers were classified as "appropriate" when the emergency status of the patient could not be resolved by the referring ED. The primary outcome was AET, which was reviewed by an expert panel for reliability. Statistically significant variables were selected as covariates based on the results of a univariate analysis, and a multivariate logistic regression analysis was performed to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) on the AET. RESULTS: A total of 1325 patients underwent transfer to another hospital from the two EDs. Of these, 1003 were classified into the emergency transfer group. In both EDs, the incidence of appropriate emergency transfers was significantly higher when the primary referring physician was an emergency physician (OR 4.005, 95% CI 2.619-6.125 and OR 4.006, 95% CI 1.696-9.459 for each hospital, respectively). CONCLUSION: There was a positive association between the specialty of the primary referring physician and the AET among EDs located in rural areas making patient transfers.