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General Surgery

Category: Quickshot Oral Session 04

Quickshot Oral : Quickshot Oral Session 04

EMERGENCY GENERAL SURGERY TRANSFERS TO DEFINITIVE CARE: AN ASSESSMENT OF PATIENT AND SYSTEMIC FACTORS IN APPENDICITIS REFERRALS

Saturday, February 11, 2023
3:00pm – 4:00pm East Coast USA Time

    Presenter(s)

  • Jill M. Kanney, MD

    General Surgery Resident, PGY3
    Novant Health New Hanover Regional Medical Center, United States

    • Principal Contact(s)

  • Jill M. Kanney, MD

    General Surgery Resident, PGY3
    Novant Health New Hanover Regional Medical Center, United States

Objectives: Patients presenting to the ED with an Emergency General Surgery (EGS) problem often require transfer to a tertiary facility, as less than 50% of hospitals can manage such patients. Issues that impact EGS mirror the same issues trauma surgery faced prior to the implementation of current trauma guidelines. The purpose of this study was to analyze the cost, time, and transport resource utilization of EGS patients with acute appendicitis when transferred from network hospitals to a community level II trauma center.

Methods: This was an IRB approved retrospective study of adult patients with appendicitis transferred from in-network EDs to a single tertiary care facility between May 2015 and September 2020. Data collected included patient demographics, hemodynamics, timeliness of referral and transport, transport level of care, social determinants of health, and patient charges. Data was analyzed with r version 1.0.2. Primary outcome was hospital length of stay. Secondary outcomes were time from initial presentation to incision, cost to patient, and transport resource allocation.

Results: 480 transfers were included in the study. Patients were transferred by a critical or specialty care (CCT or SCT) team 62% of the time, although no skills performed required an SCT or CCT provider. The median time from decision to transfer to incision was 254 minutes, with an average transport time of 27 minutes. 47.5% of transferred patients were not taken directly to the OR and required an ED or Floor bed upon arrival; this significantly increased hospital length of stay for these individuals.

Conclusion: This single center study suggests that there is an opportunity to improve access to the OR and to decrease resource utilization of specialty care and critical care transport for patients. Developing a protocol for routine EGS diagnoses to be transported directly to the OR could decrease cost and length of stay.