Interfacility transfers for stroke are increasing—maybe too much, researchers say
The odds of stroke patients being transferred from one hospital to another more than doubled from 2006 to 2014, according to a study published online April 4 in Neurology.
While this is good for patients who may need more advanced care than a small community or rural hospital can provide, it is also important to limit the number of unnecessary transfers, the researchers pointed out.
“The underlying goal of stroke care is to get the right person to the right hospital at the right time,” said study coauthor Benjamin George, MD, MPH, a neurologist at University of Rochester Medical Center (URMC). “The findings of this study show that in recent years community-based hospitals are erring on the side of caution and transferring more patients from their emergency departments to larger hospitals. Given the high cost and burden associated with these transfers, striking a balance between cost and need is essential.”
George and colleagues noted the growth of regional healthcare networks likely contributed to this boom in interfacility transfers. Using the U.S. Nationwide Emergency Department Sample, the researchers estimated the amount of transfers for ischemic stroke or transient ischemic attack (TIA) increased from 22,576 in 2006 to 54,485 in 2014. Overall, rates of transfer for ischemic stroke/TIA jumped from 3.4 to 7.6 percent over that period, and transfer rates were highest from rural emergency departments.
The authors noted neurocritical care and thrombectomy are often unavailable at smaller hospitals, making those transfers necessary and important. But in the cases of TIA and less severe strokes, transfers may be unnecessary and result in increased costs and unneeded inconvenience to patients and their families.
Better coordination between hospitals could lead to more judicious transfer decisions, the authors suggested. Establishing stroke evaluation protocols and using telecommunication to consult specialists in other institutions prior to making a transfer decision could help in this regard.
"Recent advances in care have transformed the way we treat stroke and the partnerships between hospitals that have formed as a result of the creation of regional health systems has expanded access to that care for more patients," said study coauthor Robert Holloway, MD, MPH, chair of the URMC Department of Neurology. “But the goal of these partnerships should be, when appropriate, to deliver care that keeps patients closer to home and this study shows that on a national level there remains work to be done when it comes to stroke patients."
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.