Scant justification for interhospital transfers: A cause of reduced efficiency in the emergency department

INTRODUCTION: Interhospital transfers are one of the critical points of the emergency system, which often cause overcrowding of the emergency department (ED) and limit its effectiveness. METHODS: A retrospective study was carried out, analyzing the clinical case files concerning the ED of the Policlinico "Umberto I" in Rome (Latium region, Italy) with the aim of establishing the reasons for the numerous unjustified transfers. RESULTS: From 1 January to 30 June 2006, 77 597 admissions to the ED occurred, and 861 patients (1.1%) were sent from other hospitals. 361 patients out of 861 (41.9%) were transferred with critical clinical conditions. The remaining 500 patients (58.1%) were transferred requiring specialised care. The need for specialised care was confirmed in 230 cases (46.0%) and therefore these transfers could be considered justified. The other 270 transfers (54.0%) were unjustified: 138 patients remained in the hospital to which they had been sent, contributing to crowding of the ED; 132 patients were returned, thereby placing them at additional risk. CONCLUSION: Unfamiliarity with the regulations governing interhospital transfers is the main cause of scantly justified transfers and the consequent reduction in efficiency of the ED in the receiving hospital.