The healthcare system labels hospitals by their capacity to care for different injuries, and when a patient has more severe injuries than a hospital can handle, they should be transferred to a higher-level trauma emergency department. However, after an expensive or inconvenient transfer, many of these injured patients are discharged home without receiving any additional treatment. A group of researchers, including Dr. Laura Medford-Davis at Baylor College of Medicine, examined the transfers of more than 48,000 patients to determine if the transfer was necessary and if care is being overused. The multi-state study appears in the American Journal of Emergency Medicine.
“Through my experiences in trauma centers, I’d see patients who had been transferred for trauma care, and oftentimes, it didn’t seem like they had the medical need to be seen at a trauma center emergency department for a second time,” said Medford-Davis, assistant professor of emergency medicine at Baylor. “I wanted to find out how often this was happening and begin formulating ideas as to how we can help alleviate the burden on patients and hospitals of unnecessary transfer cases.”
Of the 48,160 cases the research team studied, they were surprised to find that despite the intent of the trauma system to move patients to the most capable trauma center, 49 percent were transferred from an ED to a non-trauma center. 22,011 patients were transferred to a center with higher level of trauma care as expected, but 36 percent of those patients were discharged without additional procedures or admission.
Patients were more likely to be discharged after transfer with injuries to the face, hands or head, as opposed to injuries to the chest or abdomen.
“Wounds or trauma to hands, face or head may have warranted additional care, and they are commonly treated by sub-specialists who are not available in all hospitals, so these patients were likely transferred to see a physician who specializes in those areas, but were subsequently discharged because the specialist determined the injury was not severe and additional care was not necessary,” explained Medford-Davis.
Overall, transfers result in additional costs and time lost for the patient, and final decisions are rarely communicated back to the initial ED or physician who transferred them.
“Based on our findings, it seems like telemedicine could be a valuable resource for these transfer cases. Connecting patients and emergency physicians with sub-specialists virtually could reveal that no further care is needed before a costly transfer. We hope this research encourages change in how trauma patients with sub-specialty injuries are managed, and improves the communication between different hospital systems,” said Medford-Davis.
Other contributors to this work include Kit Delgado, Daniel Holena, David Karp, and Michael Kallan. This study was supported by the National Institutes of Health NHLBI Career Development Program in Emergency research and the RWJF Clinical Scholars Program.