Citation

Gómez D, Haas B, Larsen K, Alali AS, Macdonald RD, Singh JM, Tien H, Iwashyna TJ, Rubenfeld GD, Nathens AB. J. Trauma Acute Care Surg. 2016; 81(4): 658-665.

Affiliation

1Department of Surgery, Division of General Surgery, University of Toronto, ON, Canada 2Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada 3Interdepartmental Division of Critical Care, University of Toronto, ON, Canada 4Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada 5Department of Geography and Planning, University of Toronto, ON, Canada 6Ornge Transport Medicine, Mississauga, Ontario, Canada 7Department of Medicine, Division of Emergency Medicine, University of Toronto, ON, Canada 8Toronto Western Research Institute, Toronto Western Hospital, Toronto, ON, Canada 9Department of Internal Medicine, University of Michigan Medical School, MN, US.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001187

PMID

27488492

Abstract

BACKGROUND: Over half of severely injured patients are initially transported from the scene of injury to non-trauma centers (NTC), with many requiring subsequent transfer to trauma center (TC) care. Definitive care in the setting of severe injury is time sensitive. However, transferring severely injured patients from a NTC is complex process often fraught with delays. Selection of the receiving TC and the mode of interfacility transport both strongly influence total transfer time, and are highly amenable to quality improvement initiatives.

METHODS: We analyzed transfer strategies, defined as the pairing of a destination and mode of transport (land vs. rotary-wing vs. fixed-wing), for severely injured adult patients. Existing transfer strategies at each NTC were derived from trauma registry data. Geographic Information Systems network analysis was used to identify the strategy that minimized transfer times the most as well as alternate strategies (+15 or +30 minutes) for each NTC. Transfer network efficiency was characterized based on optimality and stability.

RESULTS: We identified 7,702 severely injured adult patients transferred from 146 NTCs to 9 TCs. NTCs transferred severely injured patients to a median of 3 (IQR1-4) different TCs and utilized a median of 4 (IQR 2-6) different transfer strategies. After allowing for the use of alternate transfer strategies, 73.1% of severely injured patients were transported using optimal/alternate strategies and only 40.4% of NTCs transferred >90% of patients using an optimal/alternate transfer strategy. Three quarters (75.5%) of transfers occurred between NTCs and their most common receiving TC.

CONCLUSIONS: More than a quarter of patients with severe traumatic injuries undergoing inter-facility transport to a TC in Ontario are consistently transported using a non-optimal combination of destination and mode of transport. Our novel analytic approach can be easily adapted to different system configurations and provides actionable data that can be provided to NTCs and other stakeholders. LEVEL OF EVIDENCE: IV STUDY TYPE: mixed-methods retrospective cohort study and Geographic information Systems network analysis.

Language: en