Effects of an emergency transfer coordination center on secondary overtriage in an emergency department

Abstract

BACKGROUND: Patients who cannot be stabilized at a lower-level emergency department (ED) should be transferred to an upper-level ED by emergency medical services. However, some patients are subsequently discharged after transfer without any intervention or admission, and this secondary overtriage (SO) wastes the limited resources of upper-level EDs. This study aimed to investigate whether an emergency transfer coordination center (ETCC) could reduce the risk of SO among patients who were transferred to a tertiary ED by emergency medical services.

METHODS: This retrospective observational study evaluated data from a prospective registry at an urban tertiary ED in Korea (January 2017 to May 2017). The exposure of interest was defined as ETCC approval prior to transfer and the primary outcome was SO. Univariate analyses were used to identify statistically significant variables, which were used for a multivariate logistic regression analysis to estimate the effects of ETCC approval on SO.

RESULTS: During the study period, 1270 patients were considered eligible for this study. A total of 291 transfers were approved by the center's ETCC, and the remaining patients were transferred without approval. Compared to cases without ETCC approval, cases with transfer after ETCC approval had a significantly lower risk of SO (odds ratio: 0.624, 95% confidence interval: 0.413-0.944).

CONCLUSION: Transfers that were evaluated by an ETCC had a lower risk of SO, which may improve the appropriateness of transfer. Thus, tertiary EDs that have high proportions of transferred patients should have a transfer coordination system that is similar to an ETCC.