{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:35:02Z","timestamp":1760146502311,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T00:00:00Z","timestamp":1731456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Effective management of acute pancreatitis (AP) hinges on prompt volume resuscitation and is adversely affected by delays in diagnosis. Given diverse clinical settings (tertiary care vs. community hospitals), further investigation is needed to understand the impact of the initial setting to which patients presented on clinical outcomes and quality of care. This study aimed to compare outcomes and quality indicators between AP patients who first presented to the emergency department (ED) of a tertiary care center and AP patients transferred from community hospitals. Methods: This study included AP patients managed at our tertiary care hospital between 2008 and 2018. We compared demographics and outcomes, including length of stay (LOS), intensive care unit (ICU) admission, rates of local and systemic complications, re-admission rates, and one-year mortality in transferred patients and those admitted from the ED. Quality indicators of interest included duration of volume resuscitation, time until advancement to enteral feeding, pain requiring opioid medication [measured in morphine milliequivalent (MME) dosing], and surgical referrals for cholecystectomy. Categorical variables were analyzed by chi-square or Fisher\u2019s exact test; continuous variables were compared using Kruskal\u2013Wallis tests. Regression was performed to assess the impact of transfer status on our outcomes of interest. Results: Our cohort of 882 AP patients comprised 648 patients admitted from the ED and 234 patients transferred from a community hospital. Transferred patients were older (54.6 vs. 51.0 years old, p &lt; 0.01) and had less frequent alcohol use (28% vs. 39%, p &lt; 0.01). Transferred patients had a significantly greater frequency of gallstone AP (40% vs. 23%), but a lower frequency of alcohol AP (16% vs. 22%) and idiopathic AP (29% vs. 41%) (p &lt; 0.001). Regarding clinical outcomes, transferred patients had significantly higher rates of severe AP (revised Atlanta classification) (10% vs. 2% severe, p &lt; 0.001) and ICU admission (8% vs. 2%, p &lt; 0.001) and longer median LOS (5 vs. 4 days, p &lt; 0.001). Regarding quality indicators, there was no significant difference in the number of days of intravenous fluid administration, or days until advancement to enteral feeding, pain requiring opioid pain medication, or rates of surgical referral for cholecystectomy. Conclusions: Though the quality of care was similar in both groups, transferred patients had more severe AP with higher rates of systemic complications and ICU admissions and longer LOS, with no difference in quality indicators between groups.<\/jats:p>","DOI":"10.3390\/jcm13226817","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T06:23:16Z","timestamp":1731478996000},"page":"6817","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Interhospital Transfer on Outcomes in Acute Pancreatitis: Implications for Healthcare Quality"],"prefix":"10.3390","volume":"13","author":[{"given":"Tamara F.","family":"Kahan","sequence":"first","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7386-0384","authenticated-orcid":false,"given":"Matthew Antony","family":"Manoj","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankit","family":"Chhoda","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anabel","family":"Liyen Cartelle","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaharyar A.","family":"Zuberi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven D.","family":"Freedman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunil G.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1053\/j.gastro.2021.10.017","article-title":"Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021","volume":"162","author":"Peery","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Li, C., Jiang, M., Pan, C., Li, J., and Xu, L. (2021). The global, regional, and national burden of acute pancreatitis in 204 countries and territories, 1990\u20132019. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01906-2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"482","DOI":"10.7326\/M16-0650","article-title":"Prediction Models of Mortality in Acute Pancreatitis in Adults: A Systematic Review","volume":"165","author":"Di","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S2468-1253(16)30004-8","article-title":"Global incidence and mortality of pancreatic diseases: A systematic review, meta-analysis, and meta-regression of population-based cohort studies","volume":"1","author":"Xiao","year":"2016","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"419","DOI":"10.14309\/ajg.0000000000002645","article-title":"American College of Gastroenterology Guidelines: Management of Acute Pancreatitis","volume":"119","author":"Tenner","year":"2024","journal-title":"Off. J. Am. Coll. Gastroenterol.|ACG"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1056\/NEJMe2209132","article-title":"Fluid Resuscitation in Acute Pancreatitis\u2014Going over the WATERFALL","volume":"387","author":"Gardner","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1053\/j.gastro.2020.12.017","article-title":"Optimum Fluid Therapy in Acute Pancreatitis Needs an Alchemist","volume":"160","author":"Garg","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.pan.2021.11.009","article-title":"Effects of immediate or early oral feeding on acute pancreatitis: A systematic review and meta-analysis","volume":"22","author":"Yao","year":"2022","journal-title":"Pancreatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"435","DOI":"10.12788\/jhm.2747","article-title":"Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation","volume":"12","author":"Mueller","year":"2017","journal-title":"J. Hosp. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1136\/qshc.2009.033480","article-title":"The published literature on handoffs in hospitals: Deficiencies identified in an extensive review","volume":"19","author":"Cohen","year":"2010","journal-title":"BMJ Qual. Saf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e752","DOI":"10.1097\/PTS.0000000000000501","article-title":"Patient and Physician Experience with Interhospital Transfer: A Qualitative Study","volume":"17","author":"Mueller","year":"2021","journal-title":"J. Patient Saf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/jhm.2515","article-title":"Interhospital transfer patients discharged by academic hospitalists and general internists: Characteristics and outcomes","volume":"11","author":"White","year":"2016","journal-title":"J. Hosp. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/PTS.0000000000000148","article-title":"Interhospital facility transfers in the United States: A nationwide outcomes study","volume":"13","author":"Davies","year":"2017","journal-title":"J. Patient Saf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1136\/bmjqs-2018-008087","article-title":"Inter-hospital transfer and patient outcomes: A retrospective cohort study","volume":"28","author":"Mueller","year":"2019","journal-title":"BMJ Qual. Saf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_16","unstructured":"CDC (2024, October 21). International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Available online: https:\/\/www.cdc.gov\/nchs\/icd\/icd-10-cm\/index.html."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20142012: Revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","journal-title":"Gut"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1136\/gut.2008.152702","article-title":"The early prediction of mortality in acute pancreatitis: A large population-based study","volume":"57","author":"Wu","year":"2008","journal-title":"Gut"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gao, W., Yang, H.-X., and Ma, C.-E. (2015). The value of BISAP score for predicting mortality and severity in acute pancreatitis: A systematic review and meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0142025"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2514","DOI":"10.1007\/s10620-019-05674-8","article-title":"Quality of Care Indicators in Patients with Acute Pancreatitis","volume":"64","author":"Ketwaroo","year":"2019","journal-title":"Dig. Dis. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1016\/j.cgh.2023.01.007","article-title":"AGA Institute Quality Indicator Development and Uses","volume":"21","author":"Sheth","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1159\/000055899","article-title":"Can fluid resuscitation prevent pancreatic necrosis in severe acute pancreatitis?","volume":"2","author":"Brown","year":"2002","journal-title":"Pancreatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/00006676-200005000-00005","article-title":"Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis","volume":"20","author":"Brown","year":"2000","journal-title":"Pancreas"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.pan.2018.10.005","article-title":"Impact of timing of presentation of acute pancreatitis to a tertiary care centre on the outcome","volume":"19","author":"Mallick","year":"2019","journal-title":"Pancreatology"},{"key":"ref_26","first-page":"356","article-title":"Quantifying clinical data quality using relative gold standards","volume":"2010","author":"Kahn","year":"2010","journal-title":"AMIA Annu. Symp. Proc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6817\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:31:27Z","timestamp":1760113887000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6817"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,13]]},"references-count":26,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226817"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226817","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,11,13]]}}}