Emergency Department Interfacility Transfers Requiring Critical Procedures are Increasing: A United States Nationwide Analysis

Background Given the changing landscape of healthcare since the COVID-19 pandemic, many hospitals have reduced or limited services, leading to increased interfacility transfers. Appropriate management by emergency medical services (EMS) requires specialized training and resources, particularly for critically ill patients status post critical procedures. Objectives This study aimed to quantify and trend the number of interfacility transfers involving critical procedures from United States (US) emergency departments (EDs) from 2018 to 2022. Methods The study is a retrospective cross-sectional study using the 2018–2022 Nationwide Emergency Department Sample (NEDS) datasets. Adult patient encounters (≥18 years old) transferred from EDs to other short-term hospitals were included. Critical procedures performed in the ED were identified using procedure codes for tracheal intubation, noninvasive ventilation, blood transfusion, central line insertion, chest tube insertion, arterial line insertion, transcutaneous pacing, and transvenous pacing. Counts and estimates with 95% confidence intervals (CIs) were weighted to account for the complex survey design. Results During the study period, an estimated 9867701 (95% CI 9475559–10259843) adult patients were transferred from US EDs. Among those transferred, 655442 (6.6%, 95% CI 6.4–6.9) had at least 1 critical procedure. Time in years was associated with any critical procedure, with an odds ratio of 1.09 (95% CI 1.07–1.11). After adjusting for patient and hospital characteristics, the estimate remained unchanged, with an adjusted odds ratio of 1.09 (1.07–1.11). The association was significantly positive for all critical procedures, except for transcutaneous and transvenous pacing. Conclusions The rising number of interfacility transfers involving critical procedures underscores the need for enhanced EMS resources and training. This trend highlights the growing demands on EMS systems to manage complex patient needs during transfers.