Regional Transfer Center Effects on Vascular Surgery Volume and Surgeon Well-being
Godfrey Ross Parkerson, Eric Kravetz, W Charles Sternbergh, III, Samuel Money
Ochsner Clinic Foundation, New Orleans, LA
INTRODUCTION: Vascular surgery patients require specialized care that many community hospitals do not provide on a 24 hour basis. We sought to investigate the frequency of transfer and tele-consult services (TTC’s) for vascular surgery at a tertiary care center and the impact of these patients on vascular surgery volumes and work load.
METHODS: A retrospective review of prospectively collected data from a regional referral center and electronic medical records from 1/1/2019 - 12/31/22 was performed. Variables analyzed included admission frequency, surgical frequency, timing of TTC requests, and distance traveled of transferred patients.
RESULTS: Over the study period there was a total of 994 TTC’s made up of 582 transfers (58.6%) and 412 tele-consults (41.4%) for which transfer was not warranted. From 2019 to 2020, TTC’s increased by 27% (likely due to COVID) and that increase was essentially sustained through 2022. Operative intervention was required for 63.7% (371/582) of all transferred patients during hospitalization. These TTC patients accounted for 6.1% of overall vascular operative volume during the study period. Among transferred patients, 9.5 % were not admitted. Transfer center admissions constituted 37.2% of Vascular ER admissions and 11% of inpatient vascular admissions over the study period (outpatient surgical admits were excluded). Chronological distribution of TTC’s showed a higher percentage between 6pm-12am compared to the remaining 6 hour periods of the day (p < .05; CI 2.42-22.75). The majority of transfers traveled in excess of 40 miles.
CONCLUSIONS: The disproportionate distribution TTC times in our study suggests a trend of offloading vascular patients from community hospitals during evening hours. While a significant portion of these patients required operative intervention, this comprised a modest amount of the total vascular operative volume. Although the ability to provide tele-consult services can help avoid unnecessary expenses/transportation for patients, the weight of this service on physician work load is substantial. While almost half of TTC’s did not result in a transfer, we assumed malpractice liability for these patients despite no reimbursement for services. In this era of production-based compensation, the intrusion of unreimbursed off-hour calls is an increasing challenge to creating a sustainable work-life balance. Further study is indicated to elucidate the potential deleterious effects of an active transfer center on surgeon wellness at other tertiary referral centers.
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