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Critical Care  2001 

Survival of patients transferred to tertiary intensive care from rural community hospitals

DOI: 10.1186/cc993

Keywords: decision-making, interhospital transport, rural health services, survival analysis

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Abstract:

In a prospective design, we identified and recorded the mortality ratio, percentage of unanticipated deaths, length of stay in the intensive care unit (ICU), and survival time of 147 patients transferred directly from other hospitals and 178 transferred from the wards within a rural tertiary-care hospital.The two groups did not differ significantly in the characteristics measured. Differences in access to tertiary critical care in this rural region did not affect survival or length of stay after admission to this tertiary ICU. The odds ratio (1.14; 95% confidence interval 0.72-1.83) for mortality associated with transfer from a rural community hospital was not statistically significant.Patients at community hospitals in this area who develop need for tertiary critical care are just as likely to survive as patients who develop ICU needs on the wards of this rural tertiary-care hospital, despite different accessibility to tertiary intensive-care services.Some hospitalized medical and surgical patients develop the need for critical-care resources that are available only at tertiary hospitals. Differences in accessibility to tertiary intensive care exist among hospitals within a rural region. For example, some patients are admitted from rural community hospitals that do not provide the same access to critical-care resources as is available to patients in the wards of tertiary hospitals. Therefore, the location of care (rural community hospital versus tertiary care center) before admission to a tertiary intensive care unit (ICU) may affect outcome.Determining whether accessibility is associated with outcome is important for understanding the role of regionalization when providing critical care to a rural population. Currently there is little direct evidence to support regionalization of adult medical and surgical critical-care services [1]. If accessibility proves to be a determinant of outcome, then development of a regional critical-care program might be beneficial. If

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