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Citation
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Lindsey LJ, Rasmussen LS, Hendrickson LS, Frech ES, Bozell SP, Stewart KE, Kennedy RO, Cross A, Albrecht RM, Celii AM. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: As the only level one trauma center in the state, our hospital has seen an increase in the number of traumas requiring transfer for a higher level of care, placing strain on an already strained health care system. Traumas that are transferred to our facility and subsequently discharged back home indicate a subset of patients who may not be appropriate to transfer. The aim of this study is to identify commonalities between patients who were transferred for a higher level of care but do not require inpatient status and to assess patients who may benefit from a telemedicine evaluation.
METHODS: A two-year retrospective review of a prospective collected database of patients who were discharged from the ED following transfer to a Level 1 trauma center was conducted. Data included demographics, injuries, transferring facility, method of transport, activation criteria and level, additional imaging, consulting services, procedures and disposition.
RESULTS: A total of 2350 patients were transferred. Of those, 27% (632/2350) were discharged home directly from the trauma bay. Of those patients, 36% (230/632) required complex bedside intervention or subspecialty consultation prior to discharge including complex laceration repairs 53%, ophthalmology exam 24%, splinting 18%, and joint reduction 5%. 64% (402/632) of patients did not require complex bedside procedures prior to discharge. 120 hospitals transferred patients to our center during this time period. The top 10 transferring facilities accounted for 40% (948/2350) of our transfer volume.
CONCLUSIONS: Our study demonstrates that patients who are transferred to our facility and subsequently discharged have a common pattern of injuries; typically, isolated hand and face/ophthalmology. This is likely attributed to the lack of resources in rural facilities to evaluate and develop treatment plans for these injuries; however, only 36% of discharged patients required a bedside procedure. Excluding Level 1 traumas, head and spine injuries, and patients requiring complex bedside procedures, there was a 13% inappropriate rate of transfer (310/2350). Development and implementation of a telemedicine system could potentially reduce the transfer and ED discharge rate, thereby improving efficiency and allowing for reallocation of resources as appropriate. LEVEL OF EVIDENCE: Level III.
Language: en |