[Truncated abstract] Introduction: There is an absence of published data describing the interhospital transfer of Emergency Department (ED) patients in the Perth metropolitan area. Aim: This thesis seeks to establish baseline data relating to the epidemiology, outcomes and problems encountered during the interhospital transfer of ED patients. Method: Multiple study designs were used. Phase one utilised linked health datasets to determine the epidemiology and outcomes of ED interhospital transfer (2002-2006). Regression models were used to identify predictors of mortality (in-hospital and 1-day post transfer). Phase two retrospectively audited in-hospital and ambulance patient records in 400 randomly selected critical care transfers. Two time periods (January 1st to December 31st 2004 and July 1st 2006 to June 30th 2007) were compared to determine temporal changes in the quality of transfer care. Markers of quality were a change in the patient's condition and need for critical interventions following transfer. Phase three consisted of a cross-sectional survey of senior clinicians involved in transfer care (n=11) and a prospective observational cohort of interhospital transfers (n=229). This data described transfer processes and practices; ascertained problems; and elicited opinions on how these may influence patient outcome. Data were reported as qualitative themes and descriptive statistics. Some of the demands when arranging transfer were also quantified. Results: Of the 36,266 index transfers that were identified, 27,776 (76.6%) were routed to a tertiary hospital ED (ED-ED) and 2948 (8.1%) direct to an inpatient area (ED-Direct). Circulatory disease and injury or poisoning were the most common diagnostic groups transferred. Transfer volume increased by an average of 14.2% per annum from 2002-2006.
|Qualification||Doctor of Philosophy|
|Publication status||Unpublished - 2013|