Emergency Department Boarding, Inpatient Census, and Interhospital Transfer Acceptances

JAMA Network Open, Год журнала: 2025, Номер 8(5), С. e2512299 - e2512299

Опубликована: Май 28, 2025

Importance Referral hospitals in the US are experiencing unprecedented levels of crowding, leading them to increasingly refuse interhospital transfer (IHT) requests. Crowded dangerous, but refusing IHTs undermines role referral and may cause harm. Objective To measure associations hospital crowding measures (emergency department [ED] boarding inpatient census) with IHT acceptances overall for prioritized conditions. Design, Setting, Participants This cross-sectional study from January 2019 May 2023 analyzed data only academic level I trauma center a highly rural state Southwestern US, including data, ED hours, census. All calls regarding adults (age >18 years) were eligible study. Data June October 2024. Main Outcome Measures The primary outcome was proportion requests accepted on weekly monthly basis. Adjusted logistic regression used analyze time census acceptance, considering conditions (obstetrics, ST-elevation myocardial infarction [STEMI], stroke, trauma) rurality. Transfer contained request descriptors, referring facility, date call, decision (accept or decline), diagnosis, patient demographics. measured daily as sum all hours each patient. Results included 26 020 (11 267 women [43.2%]; mean [SD] age, 54.4 [19.6] years), which 16 062 (61.7%). There 22 119 (85.0%) urban 3901 (15.0%) hospitals, majority (19 912 [76.3%]) seeking an ED. negative correlation between acceptance (Pearson r , −0.73) −0.87). At times worst (highest vs lowest quartile), odds lower (adjusted ratio [aOR], 0.71; 95% CI, 0.66-0.78). Of requests, 2196 (56.3%) accepted, (aOR, 0.66; 0.64-0.79). Prioritized diagnoses more commonly particularly obstetrics 5.28; 4.17-6.70), STEMI 3.04; 1.86-4.98), 3.19; 2.86, 3.57). Conclusions Relevance In this severity associated decreased suggesting that overcrowded face tradeoffs they seek fulfill seemingly conflicting obligations safely care locally hospitalized patients accept regional transfer.

Язык: Английский

Neighborhood Socioeconomic Disadvantage and Acute Care Utilization in Washington State Medicaid: A Retrospective Cohort Study

Journal of General Internal Medicine, Год журнала: 2024, Номер unknown

Опубликована: Окт. 11, 2024

Язык: Английский