The goal of this study is to establish effective interfacility clinical support and optimize resource allocation by minimizing unnecessary transfers of patients with low grade intracranial hemorrhage (ICH).

Patients with ICH are frequently transferred to tertiary hospital for neurosurgical intervention. Many patients transferred may receive appropriate care at the facility of origin. We reviewed patients transferred to a tertiary hospital for neurosurgical evaluation.  We then created a protocol to mitigate unnecessary transfers. 

We performed a retrospective analysis of patients with low grade ICH transferred for specialized neurosurgical evaluation to a tertiary care center from January 1, 2023 to September 30, 2023.  We then created a workflow utilizing neuro-intensive care unit (ICU) consultation via telehealth to maintain appropriate patients at the sending facility. The protocol involved the community hospital calling the centralized transfer center (CTC) for neurosurgical consultation.  The neurosurgeon determined whether the patient was stable to remain at the sending hospital. Once stability was established, the CTC connected the neurointensivist to give additional recommendations. The patient was admitted to the community ICU, which could consult with the neurointensivist via telehealth on request.  

The initial assessment showed that surgical intervention occurred in only 42% of patients transferred with ICH. After implementing the new workflow model, the number of transfer requests that transitioned to consults with the patients remaining at the community hospital doubled. Further analysis showed patients who were not transferred did not require later transfer for neurological deterioration. <br bcx0"=""> 

Transferring patients with minimal ICH to a tertiary center with specialized neuro-ICUs may not be necessary to maintain appropriate care. We demonstrated that a large percentage of patients experiencing low grade ICH can safely remain at community hospitals with the support of neurointensivist telehealth care after risk stratification by a neurosurgical consult.