Comparison of Urological Transfers to Academic Medical Centers: A Multi-Institutional Perspective

ABSTRACT Objective To examine urological transfers and rate of tertiary center interventions from four geographically distinct academic medical centers. Methods Four academic medical centers were selected for this study including Baylor College of Medicine (BCM), University of Alabama at Birmingham (UAB), University of Kentucky (UK), and University of Pennsylvania Hospital (Penn). BCM and Penn primarily service large metropolitan city centers and UK and UAB primarily service large rural populations. Transfer logs were pulled for each institution over a two-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into one of 11 mutually exclusive categories. Results Overall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the two rural centers, and 30.7% (302/984) were transferred to the two metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302). Conclusions Given that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.