Transfer to a public hospital. A prospective study of 467 patients

Robert L. Schiff, David A. Ansell, James E. Schlosser, Ahamed H. Idris, Ann Morrison, Steven Whitman

Research output: Contribution to journalArticle

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Abstract

In recent years there has been a dramatic increase in the number of patients transferred to public hospitals in the United States. We prospectively studied 467 medical and surgical patients who were transferred from the emergency departments of other hospitals in the Chicago area to Cook County Hospital and subsequently admitted. Eighty-nine percent of the transferred patients were black or Hispanic, and 81 percent were unemployed. Most (87 percent) were transferred because they lacked adequate medical insurance. Only 6 percent of the patients had given written informed consent for transfer. Twenty-two percent required admission to an intensive care unit, usually within 24 hours of arrival. Twenty-four percent were in an unstable clinical condition at the transferring hospital. The proportion of transferred medical-service patients who died was 9.4 percent, which was significantly higher than the proportion of medical-service patients who were not transferred (3.8 percent, P < 0.01). There was no significant difference in the proportion of deaths on the surgical service between patients who were transferred and those who were not (1.5 vs. 2.4 percent). We conclude that patients are transferred to public hospitals predominantly for economic reasons, in spite of the fact that many of them are in an unstable condition at the time of transfer.

Original languageEnglish (US)
Pages (from-to)552-557
Number of pages6
JournalNew England Journal of Medicine
Volume314
Issue number9
StatePublished - 1986

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Public Hospitals
Prospective Studies
Hospital Economics
County Hospitals
Insurance
Informed Consent
Hispanic Americans
Intensive Care Units
Hospital Emergency Service

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Schiff, R. L., Ansell, D. A., Schlosser, J. E., Idris, A. H., Morrison, A., & Whitman, S. (1986). Transfer to a public hospital. A prospective study of 467 patients. New England Journal of Medicine, 314(9), 552-557.

Transfer to a public hospital. A prospective study of 467 patients. / Schiff, Robert L.; Ansell, David A.; Schlosser, James E.; Idris, Ahamed H.; Morrison, Ann; Whitman, Steven.

In: New England Journal of Medicine, Vol. 314, No. 9, 1986, p. 552-557.

Research output: Contribution to journalArticle

Schiff, RL, Ansell, DA, Schlosser, JE, Idris, AH, Morrison, A & Whitman, S 1986, 'Transfer to a public hospital. A prospective study of 467 patients', New England Journal of Medicine, vol. 314, no. 9, pp. 552-557.
Schiff RL, Ansell DA, Schlosser JE, Idris AH, Morrison A, Whitman S. Transfer to a public hospital. A prospective study of 467 patients. New England Journal of Medicine. 1986;314(9):552-557.
Schiff, Robert L. ; Ansell, David A. ; Schlosser, James E. ; Idris, Ahamed H. ; Morrison, Ann ; Whitman, Steven. / Transfer to a public hospital. A prospective study of 467 patients. In: New England Journal of Medicine. 1986 ; Vol. 314, No. 9. pp. 552-557.
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