Effects of patient-level risk factors, departmental allocation and seasonality on intrahospital patient transfer patterns: network analysis applied on a Norwegian single-centre data set

Objectives: Describe patient transfer patterns within a large Norwegian hospital. Identify risk factors associated with a high number of transfers. Develop methods to monitor intrahospital patient flows to support capacity management and infection control.

Design: Retrospective observational study of linked clinical data from electronic health records.

Setting: Tertiary care university hospital in the Greater Oslo Region, Norway.

Participants: All adult (≥18 years old) admissions to the gastroenterology, gastrointestinal surgery, neurology and orthopaedics departments at Akershus University Hospital, June 2018 to May 2019.

Methods: Network analysis and graph theory. Poisson regression analysis.

Outcome measures: Primary outcome was network characteristics at the departmental level. We describe location-to-location transfers using unweighted, undirected networks for a full-year study period. Weekly networks reveal changes in network size, density and key categories of transfers over time. Secondary outcome was transfer trajectories at the individual patient level. We describe the distribution of transfer trajectories in the cohort and associate number of transfers with patient clinical characteristics.

Results: The cohort comprised 17 198 hospital stays. Network analysis demonstrated marked heterogeneity across departments and throughout the year. The orthopaedics department had the largest transfer network size and density and greatest temporal variation. More transfers occurred during weekdays than weekends. Summer holiday affected transfers of different types (Emergency department-Any location/Bed ward-Bed ward/To-From Technical wards) differently. Over 75% of transferred patients followed one of 20 common intrahospital trajectories, involving one to three transfers. Higher number of intrahospital transfers was associated with emergency admission (transfer rate ratio (RR)=1.827), non-prophylactic antibiotics (RR=1.108), surgical procedure (RR=2.939) and stay in intensive care unit or high-dependency unit (RR=2.098). Additionally, gastrosurgical (RR=1.211), orthopaedic (RR=1.295) and neurological (RR=1.114) patients had higher risk of many transfers than gastroenterology patients (all effects: p<0.001).

Conclusions: Network and transfer chain analysis applied on patient location data revealed logistic and clinical associations highly relevant for hospital capacity management and infection control.