Hong Kong Emergency Nurses Association


Cost–effectiveness and Resources Implication of Inter-facility Transport in Emergency Department

The Inter-facility Transport (IFT) service provided by emergency department becomes increasingly important, owing to the re-organization of hospital services in Hong Kong. Patients need to be rapidly transported over short distances to access appropriate health care facilities. Many studies have been done to review the compliance with Inter-facility Transport Triage guideline, risk factors and en-route physiological deteroiation and knowledge of emergency staff in the preparation of IFT. Little has been done on the resources utilization / cost-effectiveness of IFT.

From the administrative point of view, the cost-effectiveness of a hospital services implementation is crucial to forecast the budget planning in the future development. The following articles evaluated the effectiveness of transport medicine in terms of cost analysis.

List of interesting journals reviewed

  • Golestanian E, Scruggs JE, Gangnon RE, Mak RP and Wood KE (2007)
    Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center.
    Critical Care Medicine, 35(6), 1470-1476.
  • Golestanian et al (2007)
    conducted an observational cohort study to compare the lengths of stay, mortality and resources consumption between patient directly admitted and those transferred to ICU. The results found that transfer patients had longer ICU and hospital lengths of stay. However, they have similar adjusted mortality outcomes when compared with directly admitted patients. Risk stratification revealed that the lowest predicted mortality patient consumes more resources.
  • Lee SK, Zupancic, JAF, Sale J, Pendray M, Whyte R, Brabyn D, Walker R and Whyte H (2002)
    Cost-Effectiveness and Choice of Infant Transport Systems.
    Medical Care, 40(8), 705-716.
  • Lee et al (2002)
    conducted a prospective, multi-center, observational study to compare the cost-effectiveness of three types of infant transport models and derive a decision model. They found that the cost drivers of transport were volume and percent of waiting time dedicated to infant transport.
  • Borlase BC, Baxter JK, Kenney PR, Forse RA, Benotte PN and Blackburn GL (1991).
    Versus Acute Interhospital Transfers to a Surgical Intensive Care Unit: Cost and Outcome Prediction.
    Journal of Trauma-Injury Infection and Critical Care, 31(7), 915-919.
  • Borlase et al (1991)
    studied the outcome and cost in tertiary SICU admission. They concluded that active transfer patients have a significantly high mortality than the elective intra-hospital admission patients. Besides, those acute transfer patients are significant more costly irrespective of outcome.
  • Lo SM, Choi TYK, Tang, YHS, Lee LYL and Chan TSJ (2009)
    A Retrospective Review on Resources Implication of Inter-facility Transport in Emergency Department.
    Poster Presentation in Scientific Symposium in Emergency Medicine in Hong Kong.
  • Lo et al. (2009)
    conducted a retrospective review on resources implication of IFT in Hong Kong. They found that the main cost driver of IFT were number of transport, direct time cost and transport cost for return journey. The crude cost of providing IFT services by Emergency Department was $852 per patient, which was reasonable and acceptable.

The above articles highlight the importance of cost analysis in transport medicine. In view of the growing demand of IFT services in emergency department, it’s time for us to evaluate the value of IFT services and balance the cost-benefit ratio, so as to consolidate the future direction of transport medicine.

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