Abstract
Purpose :
Inter-hospital transfers can lead to delays in care, which may affect final outcomes. We aim to assess the timing of care among patients transferred from regional hospitals to an academic tertiary care system for ophthalmologic evaluation and to characterize the patients who are transferred.
Methods :
A retrospective review of electronic medical records analyzed all patient transfers to the Emergency Department (ED) of Harborview Medical Center (HMC), an academic tertiary care referral hospital and level 1 trauma center in Seattle, WA, between August 2022 and January 2023. Time intervals between 1. initiation of transfer call by an outside provider to acceptance of patient by the ophthalmology service, 2. acceptance of patient to arrival of patient in the ED, 3. arrival of patient to rooming of patient by the Emergency Medicine provider, 4. rooming of patient to ophthalmology examination, and 5. total time in the ED were recorded. Median and interquartile range (IQR) were used to describe timing of care.
Results :
Two-hundred seventeen patients were transferred from outside facilities during the study period. Mean (SD) age was 50.8 (17.9) years. By self-reported race/ethnicity, patients were most commonly Non-Hispanic White (39.2%), Black or African American (16.1%), and Hispanic/Latinx (15.2%). Most common chief complains were eye pain (40.6%), blurry vision (19.4%), and vision loss (18.9%). Of all transferred patients, 32.7% were admitted to the hospital, and 17.1% required urgent eye surgery. Median (IQR) time from initiation of transfer call to patient acceptance by the ophthalmology service was 108 minutes (71-172), from patient acceptance to patient arrival in the ED was 235 minutes (181–352), from patient arrival to rooming the patient was 10 minutes (6-27), and from rooming to ophthalmology evaluation was 139 (93-217) minutes. Median (IQR) total time in the HMC ED was 415 minutes (291-613) and from initiation of transfer call to ED discharge was 706 minutes (534-972).
Conclusions :
Total time from the initiation of an outside hospital ED transfer request to the completion of the ED visit at Harborview Medical Center varied, with most transfers seen by an ophthalmologist within three hours. Further investigation is needed to assess factors associated with longer transfer times and longer total time in ED and to compare the visit times of patients who are transferred with those who self-present to the ED.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.