Citation

Clark NM, Agoubi LL, Gibbs S, Stewart BT, De Grauw X, Vavilala MS, Rivara FP, Arbabi S, Pham TN. J. Am. Coll. Surg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1097/XCS.0000000000000854

PMID

37694925

Abstract

BACKGROUND: Regionalized care for burn-injured patients requires accurate triage. In 2016, we implemented a tele-triage system for acute burn consultations. We evaluated resource utilization following implementation, hypothesizing that this system would reduce short stay admissions and prioritize inpatient care for those with higher burn severity.

METHODS: We conducted a retrospective study of all transferred patients with acute burn injuries from 1/1/2010-12/31/2015 and 1/1/2017-12/31/2019. We evaluated proportions of short stay admissions (discharges <24 hours without operative intervention, ICU admission, or concern for non-accidental trauma) among patients transferred before (2010-2015) and after (2017-2019) triage system implementation. Multivariable Poisson regression was used to evaluate factors associated with short stay admissions. Interrupted time series analysis was used to evaluate the effect of the triage system.

RESULTS: There were 4688 burn transfers (3244 pre- and 1444 post-implementation) in the study periods. Mean age was higher post-implementation (32 vs 29 years, p<0.001). Median hospital LOS and ICU LOS were both 1 day higher, more patients underwent operative intervention (19% vs. 16%), and median time to first operation was 1 day lower post-implementation. Short stay admissions decreased from 50% (n=1624) to 39% (n=561), and patients were 17% less likely to have a short stay admission after implementation (aRR 0.83, 95% CI 0.8-0.9). Pediatric patients <15 years old composed 43% of all short stay admissions and were much more likely than adult patients to have a short stay admission independent of transfer timing (aRR 2.36, 95% CI 1.84-3.03).

CONCLUSIONS: Tele-triage burn transfer center protocols reduced short-stay admissions and prioritized inpatient care for patients with more severe injuries. Pediatric patients remain more likely to have short stay admission after transfer.

Language: en