Leveraging the Transfer Center to Improve Access to Vascular Surgical Care at a Tertiary Academic Medical Center.

BACKGROUND: Vascular surgeons are essential to maintaining a safe operating room environment for all surgical specialties, in addition to managing primary vascular diseases. The value of the vascular surgery service line within a health-care system has been well-described; however, few studies have reported the role of vascular surgeons in supporting regional hospitals lacking vascular surgical coverage. In the present study, we report our institutional experience leveraging the transfer center to improve access to vascular surgical care. METHODS: We retrospectively queried electronic medical records for all transfer center requests and external consultations to a vascular surgery service at our tertiary-care academic medical center. Data were collected on request status, transfer type, reason for transfer, timing, location of referring hospital, and total number of communications. RESULTS: From 2021 to 2023, a total of 16,340 transfer center requests were made to surgical specialties at our institution, of which 1,033 (6.3%) requested vascular surgery service. Over this 3-year period, the median number of transfer center requests were 28 per month (interquartile range [IQR], 23-34), with 5 communications (IQR 4-7) accompanying each transfer request. The most common reasons for transfer included higher level of care (n = 695, 67.3%) and lack of on-call vascular surgeons (n = 78, 7.6%). Requests originated from a total of 104 referring hospitals across 13 states, including a total of 211 (20.4%) requests from out-of-state. Of all transfer requests, 556 (53.8%) were received after-hours (n = 296), on a weekend (n = 156), or both (n = 104). Half of all requests were ultimately accepted for transfer (n = 488, 47.2%). Of these 488 cases, 359 (73.6%) underwent operative intervention within 30 days. CONCLUSION: Modern vascular surgical practice at a tertiary referral center necessitates continuous, around-the-clock surgeon availability to meet both institutional needs and external coverage. The transfer center serves as 1 mechanism for extending vascular surgical care to hospitals without on-site vascular coverage. These findings add to the expanding body of literature aimed at accurately capturing and quantifying the value of the vascular surgeon in contemporary practice.

Duke Scholars

Author Young Kim Surgery, Vascular and Endovascular Surgery

Author Kevin William Southerland Surgery, Vascular and Endovascular Surgery

Author Chandler Alexander Long Surgery, Vascular and Endovascular Surgery

Author Hope Weissler Surgery, Vascular and Endovascular Surgery

Author Tristen T Chun Surgery, Vascular and Endovascular Surgery