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Transfer or Keep Criteria : Defining emergency general surgery (EGS) patients who can remain at the rural community hospital
*Jennifer MacDowell1, Brad Cushing1, *Crystal Russell1, *Shantanu Razdan1, *Josh Barnes-Livermore1, *Jane Lee2, *Ryan Knapp2, *Eric Osborne2
1Maine Medical Center, Portland, ME;2Stephens Memorial Hospital, Norway, ME

Objective: Studies comparing EGS patient outcomes as a function of hospital resources, volume, care model and transfer / transport requirement show varying results potentially because of failure to control for variation in hospital capability. We describe a triage system that accounts for locally-assessed hospital capability. We evaluate the deployment of that system in preparation for outcome studies that employ the Transfer or Keep Criteria.
Design: Quality improvement
Setting: Ten hospital system: nine community hospitals (four of which are critical access) and one tertiary center in a NSQIP Quality Collaborative
Participants: General surgeons, ED physicians, anesthesiologists, nursing, and hospitalists
Interventions: Transfer or Keep Criteria for each hospital developed by multidisciplinary review of a standardized list of EGS conditions and medical co-morbidities to determine if resources allow patients to safely receive care locally. Transfers after criteria deployment evaluated to identify criteria compliance and opportunity for improvement.
Main Outcome Measures: Criteria compliance
Results: Patients transferred from EDs to the tertiary center, 10/1/2019 - 2/29/2020, ages 18-95
Number of Transfers
From critical access36 (40%)
Transfers on weekends 51 (56%)
Surgery after transfer 38 (42%)
Compliant with hospital-specific criteria83 (91%)
Indications for transfer
No surgeon available 5 (5%)
Acuity41 (45%)
No beds available2 (2%)
Specialty services not available 17 (18%)
Prior surgery at tertiary center 13 (14%)

Non-compliant transfers
Number of Transfers
Weekend transfer 6
Prior surgery at tertiary center 2
Surgery after transfer 1

Conclusions: Early compliance with deployment of the Transfer or Keep Criteria was high. Further evaluation of non-operated transfers and weekend resources is warranted as more data is obtained. The foundation for evaluation of the criteria vs outcome appears in-place.

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