A five-year retrospective review of Protocol 37 transfers from a model 3 hospital Emergency Department

Abstract

Aims
Protocol 37 is the process in Ireland that facilitates emergency inter-hospital transfers. We performed a five-year retrospective review of emergency transfers from a Model 3 Emergency Department (ED). The aim of the study was to identify delays and reasons for delays to transfer.

Methods
A retrospective review was completed on all Protocol 37 transfers from Sligo University Hospital (SUH) ED from 01/06/2019-01/06/2024. All data collected was analysed for documented reasons for transfer delays.

Results
There were 399 Protocol 37 transfers over the five-year period. The mean age was 56 years and 299 (75%) were triage category 2. The most common reasons for transfer were myocardial infarction (131, 33%) and ischaemic stroke (63, 16%). The local tertiary centre received 210 (53%) of the patients. 112 (28%) transfers required medical staff to travel. The mean time from ED arrival to transfer was 5 hours 5 minutes, and Protocol 37 activation to transfer was 56 minutes. 41 (10.3%) patients had documented transfer delays.

Discussion
This review identifies clear delays to emergency inter-hospital transfers from a model 3 hospital ED. This is secondary to the complexity involved in the diagnosis and management of these patients. We aim to implement a national transfer document to improve the efficiency of transfers.