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{
    "pk": 13404,
    "title": "Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions",
    "subtitle": null,
    "abstract": "Introduction:\n Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality.\nMethods:\n This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults.\nResults:\n We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%.\nConclusion: \nThe majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "emergency medical services, inter-hospital transfers, goals of care, palliative care, emergency medicine"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/51q9m6md",
    "frozenauthors": [
        {
            "first_name": "Justin",
            "middle_name": "K.",
            "last_name": "Brooten",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina\nWake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Alyssa",
            "middle_name": "S.",
            "last_name": "Buckenheimer",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Internal Medicine, Section on General Internal Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Joy",
            "middle_name": "K.",
            "last_name": "Hallmark",
            "name_suffix": "",
            "institution": "University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Carl",
            "middle_name": "R.",
            "last_name": "Grey",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "M.",
            "last_name": "Cline",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Candace",
            "middle_name": "J.",
            "last_name": "Breznau",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Tyler",
            "middle_name": "S.",
            "last_name": "McQueen",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Zvi",
            "middle_name": "J.",
            "last_name": "Harris",
            "name_suffix": "",
            "institution": "Wake Forest Graduate School of Arts and Science, Department of Biomedical Science, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "",
            "last_name": "Welsh",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Jeff",
            "middle_name": "D.",
            "last_name": "Williamson",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina\nWake Forest School of Medicine, Center for Health Care Innovation, Department of Internal Medicine, Winston-Salem, North Carolina",
            "department": "None"
        },
        {
            "first_name": "Jennifer",
            "middle_name": "L.",
            "last_name": "Gabbard",
            "name_suffix": "",
            "institution": "Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina\nWake Forest School of Medicine, Center for Health Care Innovation, Department of Internal Medicine, Winston-Salem, North Carolina",
            "department": "None"
        }
    ],
    "date_submitted": "2019-12-05T08:05:02+05:30",
    "date_accepted": "2019-12-05T08:05:02+05:30",
    "date_published": "2020-07-09T00:22:26+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/13404/galley/7038/download/"
        }
    ]
}