The Effect of Treatment Delays Associated with Inpatient Inter-hospital Transfer from Peripheral to Tertiary Hospitals for the Surgical Treatment of Cardiology Patients

Background: Nearly 100,000 presentations to non-tertiary hospitals per year result in an inpatient transfer [1]. The timely inter-hospital transfer of patients for cardiothoracic surgery is significant to their overall outcomes. We hypothesised that patients with a prolonged pre-operative admission were at risk of nosocomial infection, leading to prolonged hospitalisation, morbidity and mortality.

Methods: Patients admitted to a non-tertiary centre (Frankston Hospital, Group 1) and requiring transfer to tertiary centres for cardiac surgery were compared to patients presenting directly to tertiary centres (Alfred Hospital, Group 2; St Vincent's Hospital, Group 3) from June 2011-July 2012. Data was obtained from medical records and the National Cardiac Surgery Database.

Results: Eighty-seven patients in Group 1, 78 patients in Group 2 and 65 patients in Group 3 were identified. A higher proportion of total admission time was spent awaiting surgery in Group 1 compared to Group 2 (52.8% vs. 38.3%, p≤0.001) and Group 3 (52.8% vs. 26.3%, p≤0.001). Nosocomial infections occurred more frequently in Group 1 compared to Group 2 (20.7% vs. 5.1%, p=0.04) and Group 3 (20.7% vs. 6%, p<0.001).

Conclusion: Presentation to a non-tertiary centre requiring inpatient cardiothoracic surgery is associated with longer pre-operative waiting time and higher rates of hospital-acquired infections.