Patient transfer from a rehabilitation hospital to an emergency department : a retrospective study of an American trauma center

Abstract

Objective: To analyze medical indications and conditions for patients transferred from a rehabilitation hospital to an emergency department (ED). Are there differences in terms of which patients go to the ED during their stay and which do not? Specifically, what type of patient is most likely to be transferred?

Methodology: A retrospective study was conducted at an American adult and pediatric urban trauma center that serves 40,000 patients per year. This study compared randomly selected samples of 534 patients having been transferred to the ED from a rehabilitation hospital and 500 patients who were directly admitted to the ED from the community. Variables examined were: demographics, ED diagnosis and level of care, length of hospital stay, costs, discharge condition and return within 60days to the ED.

Results: The patients transferred from the rehabilitation hospital were older (P<0.01), differed with regard to ethnicity (83% African American; P<0.01), the reason for hospitalization (P<0.01; the majority presented with cardiovascular disease, respiratory disease or altered mental status), had longer and more expensive stays (average: 4-8days, P<0.01), required a higher level of care (P<0.01), were more often admitted to surgery or telemetry, and, lastly, were more likely to be discharged in a frail or poor condition (P<0.01).

Conclusions: The patients transferred from a rehabilitation hospital had complex, intense medical (and often psychological) issues. These patients' medical needs required a high level of resources in the ED. They frequently left the hospital in sub-optimal conditions, making it likely that they would return to the hospital via the ED prior to completing their treatment within the rehabilitation hospital.

Keywords: Comorbidity; Comorbidité; Emergency department; Patients en réadaptation; Patients en transfert; Rehabilitation patients; Service des urgences; Transfer patients.