Differences in Emergency Department Transfers Despite the Emergency Medical Treatment and Labor Act (EMTALA)

Because hospitals transfer emergency department patients when they lack capability, transfers are critical to ensuring access to emergency care. The project will examine the following three aims: (1) measure differences in ED length of stay in different subgroups, and determine whether differences in length of stay are associated with differences in patient outcomes; (2) assess whether ED patients of different subgroups who require specialized care are less likely to be transferred to hospitals within the same ownership system; and (3) determine whether, among different subgroups, ED patients are more likely to be transferred to a safety-net hospital. The proposed research is innovative because it allows us to examine not just whether there are differences in ED transfer, but also whether there are differences in the timing of the ED transfer and recipient hospital, and whether this affects patient outcomes. The project will support NIMHD’s mission because it examines how ED transfers vary among two different NIH-designated populations with health disparities (low socioeconomic status and racial and/or ethnic minority populations). Variations in access to emergency department transfers impact not only individual patient outcomes, but may also indicate where emergency care delivery can be improved and where there may be inefficiency in emergency care. The proposed project is significant because these insights may be used to improve policy by providing evidence whether decreasing differences ED transfers might be best addressed through policies such as expanding protocolization of these transfers.