Exploring inter-hospital emergency patient referral network

Transferring patients between hospitals is a common and necessary element of emergency departments and patient care. Inter-hospital referrals establish a network, which is also an indicator of how well health institutions are performing. The interaction between hospitals and patient transfers can be similar to the person's relation in a social network. In the study, it is aimed to determine how the measurable differences in the service delivery of the hospitals in the Eastern Black Sea region of Türkiye affect the direction of patient referral flows between hospitals. The study encompasses inter-hospital patient transfers conducted by 112 ambulances and includes data from the years 2015, 2016, and 2017, involving 110,688 patient referrals among 42 provinces and 272 hospitals.The study was analyzed using the network analysis program NODEXL. As a result of the research, the roles and positions of the hospitals and the hospitals that were most efficient were identified. The hospitals in the region exhibit strong and heterogeneous connections with each other, indicating a high degree of coordination. Although geographic distances have an impact on patient referrals, it has also been revealed that there is a relationship between the characteristics and capacities of hospitals and their centrality. It was determined for which reasons the patients in the region were referred the most and from which disease group they were referred. It is thought that the study will contribute to the health sector on a country basis, since focusing on the analysis of all hospitals in a region is a representative of sub-component of the health system. This is the first thorough regional study in the national literature to indicate that social network analysis may be used to evaluate inter-hospital patient referrals.