An Emergency Department perspective: Ambulance transfers and referral consents of the patients

Abstract

Objective: We aimed to analyze patients who were brought into our ED by EMS ambulances.
Methods: Patients who were brought to our tertiary emergency department by ambulance for one month period were included in this prospective observational study. Patients were grouped and analyzed according to demographic characteristics, presence of obtained written referral consent and outcomes at ED.
Results: The total number of patients included in the study was 633 (58.1% men, 52.0±20.1 mean age). The most frequent ambulance drop-off time to ED was between 12: 01-16: 00 hours (21%). The majority of the patients were transferred from the scene (64.8%), 16.1% were transferred from in-province hospitals, and 19% were transferred from out-of-province hospitals. Of all, the rate of patients discharged from the ED was 53.6%. Patients without referral consent were most commonly brought from out-of-province hospitals (72%) and between 20.00-00.00 hours (28.1%). Of the total of 222 patients transferred to our hospital, 159 (72%) were brought in without referral consents. Out-of-province referral rates were significantly higher than in-province referral rates in means of having written referral consent (p<0.001, 15.3% vs 9.8% chi-square: 615.31). In 88 patients referred from in-province hospitals, 25 (28.4%) were admitted to the services, 34 (38.6%) were admitted to critical care units, and 29 (33.0%) were discharged. In a hundred and sixteen patients with urban referal, 37 (31.9%) of these admitted to service, 49 of (42.2%) admitted to critical care units, and 30 of (25.9%) discharged. There is no statical differences between patients’ referral places (in province / out of province) and admission rate (p=0.2). Admission rates were noted as 93.3% for the patients with prior referral consent vs 62.1% without (p<0.001, chi-square: 18.471).
Conclusions: The transfer of patients from other hospitals by ambulances comprises an important role among all ambulance arrivals to our ED. Majority of the transferred patients were brought in without a prior written consent, during after-business hours and from out-of province hospitals. Interhospital transfers are needed to be practiced based on standardized criteria in order to prevent the possible negative effects to the for the patients well being.