Transfer of Low-Risk Patients in Emergency General Surgery: Patient Survey on the Process of Care and Perceptions of Safety

Background: Transfer of low-risk emergency general surgery (EGS) patients from a Level I Trauma tertiary care hospital and free-standing emergency department (FS-ED) to an affiliated community hospital saves tertiary care bed days and operating room (OR) time. Patient experience with this process is unknown. The study aims to evaluate the experience and satisfaction during their surgical care episode of transferred low-risk EGS patients. Methods: EGS patients undergoing non-elective laparoscopic cholecystectomy or appendectomy were prospectively identified between May 2023 and March 2024. Patients were divided into groups based on initial assessment location and transfer status: (1) no transfer; (2) tertiary care-ED to community hospital; and (3) FS-ED to community hospital. Data collected included demographics, ED length of stay (ED-LOS), OR characteristics, and 30-day outcomes. Post-discharge, patients were surveyed on safety perceptions, satisfaction, and overall experience using five-point Likert scales and open-ended questions. Responses were analyzed using univariate and thematic analysis. Results: Of 216 patients identified, 69 participated in the post-discharge survey (32%). There were no significant differences in baseline characteristics and 30-day outcomes between groups, except for hospital LOS (P < 0.01). Most transferred patients were satisfied with the transfer process (84% from FS-ED; 75% from tertiary care hospital). There were no significant differences in information clarity and feelings of preparedness and safety at discharge by discharge location. Conclusions: Transfer of appropriate patients improves capacity and resources at tertiary care hospitals without decreasing patient satisfaction or increasing safety concerns. Standardized education on the transfer process is likely to positively impact patient experience.