Interhospital transfer (IHT) in emergency general surgery patients (EGS): A scoping review

Background/Aims of study: Interhospital transfer of emergency general surgery patients continues to rise, and no system for transfer of emergency general surgery patients exists. This has major implications for cost of care and patient experience. We performed a scoping review to understand outcomes related to transfer and the associated factors and to identify any opportunities for improvement. Methods: Studies involving emergency general surgery patients with interhospital transfer were identified by searching OVID MEDLINE, EMBASE, Cochrane Library, and Scopus. There were 1,785 records identified. After duplicates were removed, there were 1,303 articles screened in the initial phase. Fifty-eight articles were included in the second phase. Eventually, 21 articles were included in the review. Thirty-seven articles were removed during the full-text screening phase due to the following: wrong publication type (2), wrong population (8), abstract (11), outside the United States (3), and wrong study design (6). Results: Transferred patients had a higher mortality rate, were older, were more likely to be male and to undergo reoperation, and had higher resource utilization compared to patients who were not transferred. All emergency general surgery patients had a high burden of chronic disease. Unnecessary transfer, typically defined by lack of intervention and discharge within 72 hours, was reported to be 8.8% to 19%. Conclusion: Emergency general surgery patients have a high rate of comorbidities. Limited physiologic status information prior to patient transfer limits understanding of the necessity for transfer. Areas for improvement include assigning a physiologic status for all patients and utilizing telehealth. More detailed information needs to be captured to determine the appropriateness of transfer.