Often good research involves questioning quite basic assumptions. This one tests the assumption that including specialists in a rural hospital workforce will reduce the number of patients that need transfer to the base hospital. Something I think that many in the health system (and community) would consider axiomatic. But based on the results of this small study, the exact opposite may be the case. It has obvious health policy implications. Well done to those who did this study with minimal resource, and especially the students that were involved. (Garry Nixon)

Rory Miller, Elizabeth Rimmer, Katharina Blattner, Steve Withington, Stephen Ram, Meg Topping, Hemi Kaka, Anna Bergin, Joel Pirini, Michelle Smith, Garry Nixon. First published: 25 July 2023 https://doi.org/10.1111/ajr.13024

Abstract

Objective

The aim of this study was to identify the percentage of patients that were transferred from rural hospitals and who received an investigation or intervention at an urban hospital that was not readily available at the rural hospital.

Methods

A retrospective observational study.

Design

Patients were randomly selected and clinical records were reviewed. Patient demographic and clinical information was collected, including any interventions or investigations occurring at the urban referral hospital. These were compared against the resources available at the rural hospitals.

Setting

Six New Zealand (NZ) rural hospitals were included.

Participants

Patients that were transferred from a rural hospital to an urban hospital between 1 Jan 2019 and 31 December 2019 were included.

Main Outcome Measures

The primary outcome measure was the percentage of patients who received an investigation or intervention that was not available at the rural hospital.

Results

There were 584 patients included. Overall 73% of patients received an intervention or investigation that was not available at the rural hospital. Of the six rural hospitals, there was one outlier, where only 37% of patients transferred from that hospital received an investigation or intervention that was not available rurally. Patients were most commonly referred to general medicine (23%) and general surgery (18%). Of the investigations or interventions performed, 43% received a CT scan and 25% underwent surgery.

Conclusions

Most patients that are transferred to urban hospitals receive an intervention or investigation that was not available at the rural hospital.