Anand M. Prabhakar MD, Abstract Co-Author: Nothing to Disclose

Shehab Ahmed Al-Ansari MD, Abstract Co-Author: Nothing to Disclose

H. Benjamin Harvey MD, JD, Abstract Co-Author: Nothing to Disclose

James A. Brink MD, Abstract Co-Author: Nothing to Disclose

Alexander Seiji Misono MD, MBA, Presenter: Consultant, BIND Therapeutics, Inc

James Kelly, Abstract Co-Author: Nothing to Disclose

Sanjay Saini MD, Abstract Co-Author: Nothing to Disclose

Rahmi Oklu MD, PhD, Abstract Co-Author: Nothing to Disclose

One-fourth of the US population lives in a rural area, yet only 10% of physicians practice in these areas, highlighting limited access to care for these patients. Since rural hospitals are often ill equipped to handle all medical emergencies, patients are transferred to other institutions for higher level of care. These transfers are estimated to cost up to $25,000. Since imaging has been shown to be critical in the emergency setting, the goal of this study is to investigate the role of imaging in transfers to a tertiary care center from an integrated rural hospital located on an island 30 miles at sea.  

In this IRB-approved, HIPAA compliant study, medical records were reviewed to identify all patients who were transferred to our institution from 2012-2013. Medical history and type of imaging that was performed at the rural hospital prior to transfer was reviewed. Medical records at the tertiary care center and any additional or repeat imaging studies that were performed at the tertiary care center were also evaluated.  

22,075 ER visits were made to the rural hospital from 2012-2013. Of these patients, 696 (3%) patients were transferred from the rural hospital. 78% (545) of the transfers were by air and 12% (86) were by boat. The most common reasons for transfer were cardiac (121; 29%), trauma (77; 18%), GI tract (64; 15%), and neurological (54, 13%) in etiology. 92% of patients had imaging prior to transfer (47% radiograph, 41% CT, 4% MRI, 6% US). Only 1 patient (0.002%) had imaging repeated at the tertiary center due to quality concerns, the rest were deemed satisfactory. 46% of total and 69% of non-cardiac patients had positive imaging findings related to the transfer-diagnosis.

Only 3% of rural hospital ER visits required a transfer to the tertiary care center. The integrated PACS system between the hospitals streamlined diagnosis and led to rapid identification of patients for emergent transfer. Additionally, this integration nearly eliminated the need for repeat imaging, reducing healthcare costs and radiation dose to the patient.

Imaging is critical in identifying patients that require a higher level of care not possible at a rural hospital. Having experienced technicians at rural hospitals, adequate imaging equipment and an integrated PACS system can greatly assist this vulnerable population and reduce unnecessary transfers to tertiary care centers.  

Prabhakar, A, Al-Ansari, S, Harvey, H, Brink, J, Misono, A, Kelly, J, Saini, S, Oklu, R, Rural Hospital to Tertiary Medical Center: Role of Imaging in Triggering Patient Transfers by Air and Sea.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009202.html