Development of a coordinated interhospital transfer program for cardiac surgery patients

TL;DR

This study examines a coordinated interhospital transfer program for cardiac surgery patients, showing it helps provide timely care, especially for high-risk cases.

Contribution

The paper introduces a structured interhospital transfer program between a district hospital and a university center for cardiac surgery patients.

Findings

Emergent patients had higher risk profiles and shorter time from admission to surgery compared to urgent and elective patients.

In-hospital mortality was highest among emergent patients, highlighting the need for improved triage and telemedicine integration.

Coronary artery bypass grafting (CABG) was the most common procedure, especially in emergent cases.

Abstract

Timely access to specialized cardiac surgical care is essential for optimal outcomes in patients with complex cardiovascular conditions. Interhospital transfer (IHT) programs have the potential to bridge the gap between regional hospitals and tertiary centers. This study evaluates the establishment of a structured collaboration between a district hospital and a university medical center, with a coordinated interhospital transfer (IHT) program as a key component. Patient characteristics, transfer logistics, and clinical outcomes across elective, urgent, and emergent admissions were analyzed. Despite the presence of other tertiary centers in the region, the referring hospital consistently transferred patients to our center, which has become its sole cardiac surgical provider within this cooperation.

A retrospective cohort study was conducted including 793 patients transferred between January 2018 and March 2023. Patients were classified based on clinical urgency as elective (n = 240), urgent (n = 379), or emergent (n = 174). Data collected included demographics, comorbidities, ASA classification, surgical type, preoperative risk factors, transfer times, time from admission to surgery, and in-hospital mortality. Comparative analyses used Chi-squared, Kruskal-Wallis, and Mann-Whitney U tests. Kaplan-Meier curves and ROC analysis were performed for survival and time-to-surgery impact.

Emergent patients were significantly more often classified as ASA class 4 (74%) and had higher rates of preoperative myocardial infarction (55%), shock (16%), and CPR (5.2%) compared to urgent and elective patients. CABG was the predominant procedure (69%), especially among emergent cases (80%). Time from admission to surgery was significantly shorter for emergent patients (median 4 h) compared to urgent (25 h) and elective (75 h). In-hospital mortality was highest in emergent patients (6.9%, p = 0.002). ROC analysis did not reveal a predictive threshold for time-to-surgery.

A coordinated IHT program facilitates timely cardiac surgical care, particularly for high-risk emergent cases. Further refinement of triage criteria and integration of telemedicine may enhance program efficacy.

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