Coordination among emergency services. An effective model for healthcare planning

Objective: To evaluate, through an intervention study with historic controls, the optimization of patient transfer from the emergency service of a high complexity hospital -originating centre (OC)- to a hospital of less complexity -recipient centre (RC)- in winter. Material and method: The intervention consisted in the creation of the following resources and mechanisms: criteria for selection of patients suitable for transfer, exclusive communication system, designation of a time band for the transfers, obtaining pending results from complementary examinations carried out in the OC, delimitation of a specific hospitalization unit in the RC, a discharges and a pre-discharge circuit throughout the RC, written rules of coordination between the healthcare unit, the Social Work Unit and the Hospital Pharmacy Service, welcome sheet and an information circuit for primary hospitals. Results: 247 patients were transferred. No patients had to stay in the emergency area of the RC. There was no deprogramming of admissions of patients in the RC. The readmission index 30 days from discharge was 2.4%. The average stay in the recipient centre was 5.63 days. As for the standardized indices, the operational index was 0.6; the standard operational ratio, 0.6; the difference attributable to the operation, -4.0 and the impact, -706. Conclusions: The intervention in patient transfer from an emergency service of a high complexity hospital to a centre of less complexity, to avoid bringing the former to a standstill, improves the healthcare quality of the patients transferred and avoids reducing that of the recipient hospital.