Interhospital cooperation after critical and emergency care for patients with cervical–thoracic–abdominal trauma and emergency diseases in the local medical area in a typical urban city of Japan

Background

Capacity of the critical care and emergency center (CCEC) is usually restricted. Transfer of patients from CCEC is one of the most important issues in the CCEC.

Subjects and methods

We examined interhospital cooperation after critical and emergency care for life-threatening cervical–thoracic–abdominal trauma (n = 501) and thoracoabdominal emergency diseases (n = 236) who were treated with intensive care in our CCEC and were able to be discharged or transferred to another acute treatment hospital.

Results

Of the trauma patients directly transferred to our center, 48% were transferred to the 'affiliated hospitals', whose medical staffs were dispatched from the 'departments' in our university, 17% were transferred to the nonaffiliated hospitals, and 34% were directly discharged from our center. Of emergency disease patients, 28% were transferred to the affiliated hospitals, 20% were transferred to other hospitals, and 52% were directly discharged. Patients staying in our center for more than 14 days tended to be transferred to the affiliated hospital. Of trauma patients indirectly transferred from other hospital to our center, 30% and 11% were transferred to the affiliated and nonaffiliated hospitals, and 19% were directly discharged. Of emergency disease patients, these values were 21%, 7%, and 13%, respectively. Patients staying in our center for more than 14 days tended to be transferred to the affiliated hospital.

Discussion and conclusion

These results are thought to be a common situation in a typical urban city in the world. Now, the interhospital cooperation between city hospital and referral hospital does not function well because of poor understanding of retransfer to the previous hospital, resulting in dysfunction of the management of critical patients in the local medical area. It is important to construct a new interhospital-cooperation system based on the local medical area.