The effect of interfacility transfer on outcome in an urban trauma system

Avery B. Nathens, Ronald V. Maier, Susan I. Brundage, Gregory Jurkovich, David C. Grossman

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background Transporting all trauma patients to regional trauma centers is inefficient; however, the bypass of nearer, nondesignated hospitals in deference to regional trauma centers decreases mortality in the severely injured. One approach to improving efficiency is to allow the initial assessment of selected patients at lower level (Level III/IV) designated centers. We set out to evaluate whether patients initially assessed at these centers and then transferred to a Level I facility were adversely affected by delays to definitive care. Methods This is a retrospective cohort study in which the primary exposure being evaluated is initial assessment at a Level III or IV trauma center before transport to a Level I center in an urban setting. The outcomes in this transfer cohort were compared with outcomes in patients transported directly from the scene to a Level I center (direct cohort). The outcomes of interest were mortality, length of stay, and hospital charges. Multivariate analyses were used to adjust for differences in baseline characteristics across these two cohorts. Results Crude length of stay was comparable, whereas mortality was lower and charges were 40% higher in the transfer cohort (n = 281) compared with the direct cohort (n = 4,439). After adjusting for confounders, mortality and length of stay were similar and total charges were significantly greater in the transferred patients. Conclusion Interfacility transfers in a mature urban trauma system do not appear to impact on clinical outcome. However, transfer patients use significantly greater resources as measured by hospital charges. This effect is likely because of the nature of their injuries or, alternatively, delays in reaching definitive care.

Original languageEnglish (US)
Pages (from-to)444-449
Number of pages6
JournalJournal of Trauma
Volume55
Issue number3
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

Fingerprint

Trauma Centers
Wounds and Injuries
Hospital Charges
Length of Stay
Mortality
Patient Transfer
Cohort Studies
Multivariate Analysis
Retrospective Studies

Keywords

  • Interfacility transfer
  • Trauma system
  • Triage
  • Urban

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The effect of interfacility transfer on outcome in an urban trauma system. / Nathens, Avery B.; Maier, Ronald V.; Brundage, Susan I.; Jurkovich, Gregory; Grossman, David C.

In: Journal of Trauma, Vol. 55, No. 3, 01.01.2003, p. 444-449.

Research output: Contribution to journalArticle

Nathens, Avery B. ; Maier, Ronald V. ; Brundage, Susan I. ; Jurkovich, Gregory ; Grossman, David C. / The effect of interfacility transfer on outcome in an urban trauma system. In: Journal of Trauma. 2003 ; Vol. 55, No. 3. pp. 444-449.
@article{0d1471b7fb7b49bda7f2472ff76d77c1,
title = "The effect of interfacility transfer on outcome in an urban trauma system",
abstract = "Background Transporting all trauma patients to regional trauma centers is inefficient; however, the bypass of nearer, nondesignated hospitals in deference to regional trauma centers decreases mortality in the severely injured. One approach to improving efficiency is to allow the initial assessment of selected patients at lower level (Level III/IV) designated centers. We set out to evaluate whether patients initially assessed at these centers and then transferred to a Level I facility were adversely affected by delays to definitive care. Methods This is a retrospective cohort study in which the primary exposure being evaluated is initial assessment at a Level III or IV trauma center before transport to a Level I center in an urban setting. The outcomes in this transfer cohort were compared with outcomes in patients transported directly from the scene to a Level I center (direct cohort). The outcomes of interest were mortality, length of stay, and hospital charges. Multivariate analyses were used to adjust for differences in baseline characteristics across these two cohorts. Results Crude length of stay was comparable, whereas mortality was lower and charges were 40{\%} higher in the transfer cohort (n = 281) compared with the direct cohort (n = 4,439). After adjusting for confounders, mortality and length of stay were similar and total charges were significantly greater in the transferred patients. Conclusion Interfacility transfers in a mature urban trauma system do not appear to impact on clinical outcome. However, transfer patients use significantly greater resources as measured by hospital charges. This effect is likely because of the nature of their injuries or, alternatively, delays in reaching definitive care.",
keywords = "Interfacility transfer, Trauma system, Triage, Urban",
author = "Nathens, {Avery B.} and Maier, {Ronald V.} and Brundage, {Susan I.} and Gregory Jurkovich and Grossman, {David C.}",
year = "2003",
month = "1",
day = "1",
doi = "10.1097/01.TA.0000047809.64699.59",
language = "English (US)",
volume = "55",
pages = "444--449",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - The effect of interfacility transfer on outcome in an urban trauma system

AU - Nathens, Avery B.

AU - Maier, Ronald V.

AU - Brundage, Susan I.

AU - Jurkovich, Gregory

AU - Grossman, David C.

PY - 2003/1/1

Y1 - 2003/1/1

N2 - Background Transporting all trauma patients to regional trauma centers is inefficient; however, the bypass of nearer, nondesignated hospitals in deference to regional trauma centers decreases mortality in the severely injured. One approach to improving efficiency is to allow the initial assessment of selected patients at lower level (Level III/IV) designated centers. We set out to evaluate whether patients initially assessed at these centers and then transferred to a Level I facility were adversely affected by delays to definitive care. Methods This is a retrospective cohort study in which the primary exposure being evaluated is initial assessment at a Level III or IV trauma center before transport to a Level I center in an urban setting. The outcomes in this transfer cohort were compared with outcomes in patients transported directly from the scene to a Level I center (direct cohort). The outcomes of interest were mortality, length of stay, and hospital charges. Multivariate analyses were used to adjust for differences in baseline characteristics across these two cohorts. Results Crude length of stay was comparable, whereas mortality was lower and charges were 40% higher in the transfer cohort (n = 281) compared with the direct cohort (n = 4,439). After adjusting for confounders, mortality and length of stay were similar and total charges were significantly greater in the transferred patients. Conclusion Interfacility transfers in a mature urban trauma system do not appear to impact on clinical outcome. However, transfer patients use significantly greater resources as measured by hospital charges. This effect is likely because of the nature of their injuries or, alternatively, delays in reaching definitive care.

AB - Background Transporting all trauma patients to regional trauma centers is inefficient; however, the bypass of nearer, nondesignated hospitals in deference to regional trauma centers decreases mortality in the severely injured. One approach to improving efficiency is to allow the initial assessment of selected patients at lower level (Level III/IV) designated centers. We set out to evaluate whether patients initially assessed at these centers and then transferred to a Level I facility were adversely affected by delays to definitive care. Methods This is a retrospective cohort study in which the primary exposure being evaluated is initial assessment at a Level III or IV trauma center before transport to a Level I center in an urban setting. The outcomes in this transfer cohort were compared with outcomes in patients transported directly from the scene to a Level I center (direct cohort). The outcomes of interest were mortality, length of stay, and hospital charges. Multivariate analyses were used to adjust for differences in baseline characteristics across these two cohorts. Results Crude length of stay was comparable, whereas mortality was lower and charges were 40% higher in the transfer cohort (n = 281) compared with the direct cohort (n = 4,439). After adjusting for confounders, mortality and length of stay were similar and total charges were significantly greater in the transferred patients. Conclusion Interfacility transfers in a mature urban trauma system do not appear to impact on clinical outcome. However, transfer patients use significantly greater resources as measured by hospital charges. This effect is likely because of the nature of their injuries or, alternatively, delays in reaching definitive care.

KW - Interfacility transfer

KW - Trauma system

KW - Triage

KW - Urban

UR - http://www.scopus.com/inward/record.url?scp=0141857552&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0141857552&partnerID=8YFLogxK

U2 - 10.1097/01.TA.0000047809.64699.59

DO - 10.1097/01.TA.0000047809.64699.59

M3 - Article

C2 - 14501884

AN - SCOPUS:0141857552

VL - 55

SP - 444

EP - 449

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -