Interhospital Referrals from the Emergency Department of a District State Hospital in the Balıkesir Region, Türkiye: A Retrospective Analysis of Reasons, Timing, and Outcomes
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Abstract
Aim: Emergency departments play a central role in emergency referral systems by coordinating interhospital patient transfers for acute medical conditions. This study aimed to retrospectively evaluate the reasons, timing, and clinical outcomes of interhospital referrals from the emergency department of a district state hospital.
Methods: This retrospective observational study included adult patients (≥18 years) referred from the ED to other hospitals between January 1, 2025, and July 1, 2025. Demographic characteristics, diagnostic groups, referral reasons, receiving specialties, timing of referral, and clinical outcomes at the receiving hospitals were analyzed. Temporal factors (month, day of the week, and time interval) were also examined in relation to referral outcomes.
Results: During the study period, 29,156 patients presented to the ED, of whom 502 (1.72%) were referred to other hospitals. After excluding pediatric cases, 478 adult patients were included in the analysis. Referrals occurred most frequently in June (19.2%), on Tuesdays (15.9%), and during the 16:00–23:59 time interval (45.4%). The most common referral destinations were cardiology (27.8%), neurology (16.3%), and pulmonology (14.4%). Overall, 349 referred patients (73.0%) were hospitalized at the receiving institutions. No statistically significant associations were observed between referral outcomes and temporal variables (p > 0.05).
Conclusions: Interhospital referrals from the emergency department of a district state hospital constituted a small proportion of total ED admissions but resulted in a high rate of hospitalization. Referrals were predominantly related to cardiopulmonary and neurological emergencies and were mainly directed to medical specialties. The absence of significant temporal effects suggests that referral decisions were primarily driven by clinical necessity rather than time-related factors.
