Lilin Tong, Lila Medeiros, Amar Dhand, Wenya Linda Bi
Research Category: Cancer
Purpose: Interhospital transfers of brain metastasis patients in the context of acute clinical presentation can contribute to high cost and delayed patient care. We sought to understand reasons for transfer and identify potential inefficiencies in the system.
Methods: Patients (n=3037) with brain metastasis who presented to an ED in Massachusetts between 2018-2019 were analyzed from Healthcare Cost and Utilization Project state-wide databases.
Results: 6.9% of brain metastases patients presenting to the ED were transferred to another facility, either directly or indirectly after admission. Sending EDs were likely to be non-teaching hospitals and lack of neurosurgery and radiation oncology services (p<0.01). Transferred patients were enriched for neurologic presentation compared to those admitted or discharged (p<0.01). Among those transferred, ~30% did not receive a significant procedure at the second facility. 74% patients who were transferred were sent to a facility significantly farther (>3miles) than the nearest facility with neurosurgery and radiation oncology, but 30-day readmission did not differ based on distance transferred.
Conclusion: We identified a significant proportion of transfers without subsequent intervention, which may reflect ED physician discomfort with neurological symptoms. Many were transferred significant distance beyond the nearest facility with appropriate specialization, which may contribute to delays in care.
Patient transfers are needed when hospitals face a scarcity of required specialists and cannot provide the appropriate management. However, when transfers are unnecessary, they can contribute to major costs in healthcare and delays in care, which can impact patient outcome. As one of the most common brain tumors, brain metastasis is a condition seen by providers across settings, but the perceived involvement of specialist care often prompts transfer to larger tertiary care facilities. We aimed to understand patient-level and system-level factors underlying hospital transfers of brain metastases patients. We found that presentation of neurological symptoms and smaller non-teaching hospitals were more likely to result in a transfer. Among those transferred, 30% of patients did not receive significant interventions at the receiving facility. Further, a significant proportion of patients were transferred a large distance beyond the nearest center with neurosurgery/radiation oncology, which did not yield differences in patient 30-day readmission compared with patients transferred a closer distance. Large transfer distance is concerning due to increased transfer time and transfer outside of initial hospital network, which may contribute to gaps in communications and delays in care.