Miller Rory, Bell Samuel, TenEyck Lisa, Topping Meg (2021) A retrospective observational study of critically unwell patients retrieved from Thames Hospital between April 2018 and December 2020.Journal of Primary Health Care. Published online: 25 August 2021

https://doi.org/10.1071/HC21058

Abstract

Introduction 

In New Zealand, critically ill patients who present to rural hospitals are typically treated, stabilised and transferred to facilities where more appropriate resources are available.

Aim

The aim of this study was to describe patients who presented critically unwell and required retrieval from Thames Hospital in the Waikato region.

Methods

Notes were reviewed retrospectively for patients who were retrieved from Thames Hospital between 1 April 2018 and 31 December 2020. Patients were excluded if they were retrieved from the offsite birthing centre or their notes were not available to the authors.

Results

During the study period, 56 patients were retrieved by intensive care teams based at Waikato, Starship or Auckland Hospitals. Patients had a median age of 57 years and most were female (60.7%). Māori patients were over-represented in the retrieval cohort compared with the population presenting to the emergency department (30.4% vs. 20.1%, P < 0.001). We found that 41% of patients presented after-hours when there was only one senior medical officer available on site and 70 procedures were performed, including rapid sequence induction, which was required by 19.6% of patients.

Discussion

This study describes a population of critically unwell patients who were retrieved from a rural hospital. The key finding is that nearly half of these patients presented after-hours when there was only one senior medical officer available on site. This doctor also has sole responsibility for all other patients in the hospital. We recommend that referral centres streamline the retrieval processes for rural hospitals.

Comment from Garry Nixon

This study documents the characteristics of a series of patients who were retrieved by air from Thames Hospital. What we can tell is that the patients were critically ill and the transfer process was complicated and time consuming, often occurring when there was only one SMO on duty at the rural hospital end. There is a lot we don’t know because little information on transfers is routinely collected.

Carol Atmore’s recent work demonstrated that rural patients who are transferred between hospitals have a higher risk of harm. (1) Trevor Lloyd listed the elements an ideal emergency transfer from rural to base hospital in 2011.(2) But there is little other published research on the topic, no national standards or policy, and a huge variation in procedures around the country. It’s perhaps not surprising interhospital transfer is the unresolved pandemic planning issue rural hospital doctors remain most concerned about. (3)

Maybe the new Health NZ (inclusive of the dedicated rural health unit) will set national standards for interhospital transfer (and other aspects of rural healthcare delivery).

Thanks Rory, Samuel, Lisa and Meg.

1. Atmore C et al. Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study. BMJ Open. 2021;11(5):e046207.
2. Lloyd T et al. Transfers from rural hospitals in New Zealand. N Z Med J. 2011;124(1328):82-8.
3. Exploring the response to the Covid-19 pandemic at the rural hospital – base hospital interface:  experiences of New Zealand rural hospital doctors. NZMJ In print.