Otolaryngology Related Transfers

The emergency medical treatment and active labor act (EMTALA) requires that patients determined to have an emergency medical condition must be treated or transferred to a hospital that can provide appropriate treatment. Transfers may result in life saving care, however the process of patient transfer also poses a significant workload and expense. Physicians of all specialties, including otolaryngology head and neck surgery (OHNS), are familiar with this process. Given the current health care economy, this process should be evaluated to ensure maximum efficiency. Methods: Retrospective chart review of patients transferred between 7/1/08 and 6/30/09 for otolaryngology related problems. Data regarding diagnoses before and after transfer, treatments rendered, repeated tests, and estimated cost of transfer are collected and analyzed. Results: 126 patients were transferred to AMC over a one year period for otolaryngology related problems. These transfers were mainly associated with head and neck (H&N) infections (42), facial trauma (41), aerodigestive tract foreign bodies (12), H&N bleeding (18), and airway management (7). There were many discrepancies between the diagnosis at transfer versus the diagnosis after OHNS evaluation. Of 30 patients transferred for drainage of H&N abscesses, 10 (33%) did not have an abscess. Only 1 of 18 patients transferred for H&N bleeding was found to be actively bleeding upon evaluation in the AMC ER. Identical tests were repeated in many of these patients, several of which were expensive imaging studies.. Discussion: Patient transfers are often necessary to provide urgent and life saving care, and providers should error on the side of patient safety. However, the transfer process for otolaryngology related problems may be inefficient and cost ineffective at times. In order to reduce inefficiencies in the transfer process, physicians should strive to communicate accurately and effectively, as well as prevent unnecessary repeat diagnostic studies.