The following is a summary of “SISTER (system implementation of select transfers in emergency room) model to reduce ED boarding,” published in the March 2023 issue of Emergency Medicine by Westlake, et al.
For a study, researchers sought to outline a new transfer model between a level 1 trauma center and a nearby affiliate community hospital to improve emergency department (ED) flow and reduce patient boarding. The study’s primary outcome was the change in boarding hours and the percentage of boarders in the main hospital ED. Secondary objectives included analyzing how reduced boarding improves the length of stay, decreases patient morbidity and mortality, prevents patients from escalating to more acute care levels, and results in cost savings.
To analyze the impact of the transfer model, a retrospective chart review was conducted for 14 months on all patients transferred from the main hospital ED to the affiliated hospital for inpatient admission. The analysis included patient cohort characteristics, length of stay, return rates to the main hospital, rates against medical advice (AMA) dispositions, post-discharge recidivism, enterprise data on the total number of boarders, percent of boarders, and total boarding hours.
The study found that the transfer model effectively reduced boarding in the main hospital ED, decreasing the percentage of boarders from 70.6% to 63.8% (P < 0.001). Total boarding hours also decreased at both hospitals with the implementation of the transfer process. The median length of stay at the affiliated hospital was 74 hours, with only 9 upgrades to ICU admissions and 5 patients dispositioned back to the main hospital.
In conclusion, the distributive transfer model successfully reduced the number and percentage of boarders and the total boarding hours in the main hospital ED. The affiliate hospital was deemed an appropriate location for transfers, as there were minimal ICU transfers and dispositions back to the main hospital.
Reference: sciencedirect.com/science/article/pii/S0735675722007720
