Exploring interhospital transfers and partnerships in the hospital sector in New South Wales, AustraliaHassan Assareh A E , Helen M. Achat A , Jean-Frederic Levesque B C and Stephen R. Leeder D
A Epidemiology and Health Analytics, Western Sydney Local Health District, Sydney, NSW 2151, Australia. Email: email@example.com
B Centre for Primary Health Care and Equity, UNSW, Sydney, NSW 2052, Australia. Email: JeanFrederic.Levesque@health.nsw.gov.au
C Bureau of Health Information, Sydney, NSW 2067, Australia.
D Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia. Email: firstname.lastname@example.org
E Corresponding author. Email: Hassan.Assareh@health.nsw.gov.au
Australian Health Review - http://dx.doi.org/10.1071/AH16117
Submitted: 30 May 2016 Accepted: 28 September 2016 Published online: 4 November 2016
Objective The aim of the present study was to explore characteristics of interhospital transfers (IHT) and sharing of care among hospitals in New South Wales (NSW), Australia.
Methods Data were extracted from patient-level linked hospital administrative datasets for separations from all NSW acute care hospitals from 1 July 2013 to 30 June 2015. Patient discharge and arrival information was used to identify IHTs. Characteristics of patients and related hospitals were then analysed.
Results Transfer-in patients accounted for 3.9% of all NSW admitted patients and, overall, 7.3% of NSW admissions were associated with transfers (IHT rate). Patients with injuries and circulatory system diseases had the highest IHT rate, accounting for one-third of all IHTs. Patients were more often transferred to larger than smaller hospitals (61% vs 29%). Compared with private hospitals, public hospitals had a higher IHT rate (8.4% vs 5.1%) and a greater proportion of transfer-out IHTs (52% vs 28%). Larger public hospitals had lower IHT rates (3–8%) compared with smaller public hospitals (13–26%). Larger public hospitals received and retransferred higher proportions of IHT patients (52–58% and 11% respectively) than their smaller counterparts (26–30% and 2–3% respectively). Less than one-quarter of IHTs were between the public and private sectors or between government health regions. The number of interacting hospitals and their interactions varied across hospital peer groups.
Conclusion NSW IHTs were often to hospitals with greater speciality services. The patterns of interhospital interactions could be affected by organisational and regional preferences.
What is known about the topic? IHTs aim to provide efficient and effective care. Nonetheless, information on transfers and the sharing of care among hospitals in an Australian setting is lacking. Studies of transfers and hospital partnership patterns will inform efforts to improve patient-centred transfers and hospital accountability in terms of end outcomes for patients.
What does this paper add? Transfer-in patients accounted for 3.9% of all NSW admissions; they were often (61%) transferred to hospitals with greater speciality services. The number of IHTs and sharing of care among hospitals varied across hospital peer groups, and could have been affected by organisational and regional preferences.
What are the implications for practitioners? The findings of the present study suggest that different patterns of IHTs may not only have resulted from clinical priorities, but that organisational and regional preferences are also likely to be influential factors. Patient-centred IHTs and the development of guidelines need to be pursued to enhance the care and functionality of healthcare. Patient sharing should be acknowledged in hospital and regional performance profiling.
Additional keywords: benchmarking, partnership network, patient outcome.
References Ivanusa M. Reducing mortality in myocardial infarction: goal should be interhospital transfer for primary angioplasty. BMJ 2005; 330 1271
| Reducing mortality in myocardial infarction: goal should be interhospital transfer for primary angioplasty.CrossRef | 15920138PubMed |
 MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006; 354 366–78.
| A national evaluation of the effect of trauma-center care on mortality.CrossRef | 1:CAS:528:DC%2BD28Xns1ygtg%3D%3D&md5=e8cf850eab14bc4ef1fab85b9c6801aeCAS | 16436768PubMed |
 The Victorian Quality Council. Inter-hospital patient transfer – a thematic analysis of the literature. Melbourne: Rural and Regional Health and Aged Care Services Division, Victorian Government Department of Human Services; 2009.
 Iwashyna TJ, Christie JD, Kahn JM, Asch DA. Uncharted paths: hospital networks in critical care. Chest 2009; 135 827–33.
| Uncharted paths: hospital networks in critical care.CrossRef | 19265091PubMed |
 Droogh JM, Smit M, Absalom AR, Ligtenberg JJ, Zijlstra JG. Transferring the critically ill patient: are we there yet? Crit Care 2015; 19 62
| Transferring the critically ill patient: are we there yet?CrossRef | 25887575PubMed |
 Veinot TC, Bosk EA, Unnikrishnan KP, Iwashyna TJ. Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States. Soc Sci Med 2012; 75 1800–10.
| Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.CrossRef | 22884942PubMed |
 American College of Emergency Physicians Interfacility transportation of the critical care patient and its medical direction. Policy statement. Ann Emerg Med 2012; 60 677
| Interfacility transportation of the critical care patient and its medical direction. Policy statement.CrossRef | 23089103PubMed |
 Australian Commission on Safety and Quality in HealthCare (ACSQHC). Safety and quality improvement guide standard 6: clinical handover. Sydney: ACSQHC; 2012.
 NSW Health. Critical care tertiary referral networks & transfer of care (adults). Sydney: NSW Health; 2010.
 Centre for Health Record Linkage. NSW admitted patient data collection (APDC). NSW Ministry of Health. 2016. Available at: http://www.cherel.org.au/data-dictionaries [verified 23 February 2016].
 NSW Health. Population health data warehouse. 2015. Available at: http://www.health.nsw.gov.au/epidemiology/Pages/Population-health-data-warehouse.aspx [verified 23 February 2016].
 Kahn JM, Iwashyna TJ. Accuracy of the discharge destination field in administrative data for identifying transfer to a long-term acute care hospital. BMC Res Notes 2010; 3 205
| Accuracy of the discharge destination field in administrative data for identifying transfer to a long-term acute care hospital.CrossRef | 20663175PubMed |
 National Centre for Classification in Health (NCCH). Australian coding standards for ICD-10-AM and ACHI. Seventh Edition. Sydney: NCCH, Faculty of Health Sciences, The University of Sydney; 2010.
 Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43 1130–9.
| Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.CrossRef | 16224307PubMed |
 NSW Health. NSW hospital peer groups 2014. Sydney: NSW Health; 2014.
 Iwashyna TJ, Christie JD, Moody J, Kahn JM, Asch DA. The structure of critical care transfer networks. Med Care 2009; 47 787–93.
| The structure of critical care transfer networks.CrossRef | 19536030PubMed |
 Butt WW, Shann FA. Transferred patients: more complex and more costly? Med J Aust 1998; 169 42–3.
 Arthur KR, Kelz RR, Mills AM, Reinke CE, Robertson MP, Sims CA, Pascual JL, Reilly PM, Holena DN. Interhospital transfer: an independent risk factor for mortality in the surgical intensive care unit. Am Surg 2013; 79 909–13.
| 24069990PubMed |
 Bureau of Health Information (BHI). Data matters – linking data to unlock information. The use of linked data in healthcare performance assessment. Sydney: BHI; 2015.
 Donker T, Wallinga J, Slack R, Grundmann H. Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer. PLoS One 2012; 7 e35002
| Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer.CrossRef | 1:CAS:528:DC%2BC38XntFWlt78%3D&md5=a85d2d0ecbc0bb85a3c24f8bc02d2acaCAS | 22558106PubMed |
 Lomi A, Mascia D, Vu DQ, Pallotti F, Conaldi G, Iwashyna TJ, Quality of Care and Interhospital Collaboration A study of patient transfers in Italy. Med Care 2014; 52 407–14.
| A study of patient transfers in Italy.CrossRef | 24714579PubMed |
 Heffner AC, Pearson DA, Nussbaum ML, Jones AE. Regionalization of post-cardiac arrest care: implementation of a cardiac resuscitation center. Am Heart J. 2012; 164 493–501.e2.
| Regionalization of post-cardiac arrest care: implementation of a cardiac resuscitation center.CrossRef | 23067906PubMed |
 Vogel LD, Vongsachang H, Pirrotta E, Holmes JM, Sherck J, Newton C, D’Souza P, Spain DA, Wang NE. Variations in pediatric trauma transfer patterns in Northern California Pediatric Trauma Centers (2001–2009). Acad Emerg Med 2014; 21 1023–30.
| Variations in pediatric trauma transfer patterns in Northern California Pediatric Trauma Centers (2001–2009).CrossRef | 25269583PubMed |
 Lossius HM, Kristiansen T, Ringdal KG, Rehn M. Inter-hospital transfer: the crux of the trauma system, a curse for trauma registries. Scand J Trauma Resusc Emerg Med 2010; 18 15
| Inter-hospital transfer: the crux of the trauma system, a curse for trauma registries.CrossRef | 20233410PubMed |
 Assareh H, Ou L, Chen J, Hillman K, Flabouris A, Hollis SJ. Geographic variation of failure-to-rescue in public acute hospitals in New South Wales, Australia. PLoS One 2014; 9 e109807
| Geographic variation of failure-to-rescue in public acute hospitals in New South Wales, Australia.CrossRef | 25310260PubMed |