Fri., 10/17/08 Geriatrics/Reconstruction, Paper #44, 5:16 pm OTA-2008
Appropriateness of Patient Transfer with Associated Orthopaedic Injuries to a Community Level-I Trauma Center
Renn J. Crichlow, MD (n); Amer Zeni, MD (n); Greg Reveal, MD (n); Mitch Kuhl, MD (n);
Jason Heisler, DO (n); David Kaehr, MD (n); Palaniswamy Vijay, PhD (n);
OrthoIndy, Indianapolis, Indiana, USA
Purpose: Our objective was to prospectively evaluate the appropriateness, indications, risk factors, and epidemiology of patients with orthopaedic injuries transferred to a Level 1 trauma center.
Methods: Patients transferred to a Level 1 trauma center with orthopaedic injuries (N = 540) from January 1 to December 31, 2007 were categorized into those transferred directly to the orthopaedics service, group 1 (n = 290), and those in which an orthopaedic surgeon was a consultant, group 2 (n = 250). The accepting orthopaedic trauma surgeon evaluated the appropriateness by visual analog scale (VAS). Data were collected prospectively, from the time of admission and subsequently through chart review.
Results: Completely inappropriate transfers accounted for 12.5% of the cohort, and 21% were completely appropriate; the remaining 66.5% were designated as intermediate. The transfers came from an emergency department physician in 81% of cases and from an orthopaedic surgeon in 14% cases; the other 5% were either via general surgeons or internists. The average distance from the referring hospital was 54.1 ± 26 miles. Of the patients transferred to the orthopaedic service directly, 92% underwent surgery; 74% of patients transferred to other services required orthopaedic surgery. The stated reason for transfer was the need for orthopaedic subspecialty coverage (88% and 42% for group 1 and 2, respectively). Average VAS score of appropriateness, air transport, other subspecialty physician consulted, and critical care admission were other factors significantly different between the two groups. 148 cases transferred to the orthopaedic service came from an institution with an orthopaedic surgeon on call and available. 60% were transferred due to orthopaedic injury complexity, but only 39% were evaluated by an orthopaedic surgeon. Lack of orthopaedic coverage at the referring hospital accounted for 27% of transfers. Age (<65 years), insurance (nonprivate), and weekend transfer (Friday, Saturday, Sunday) were different between those with an inappropriate transfer (VAS score <2) and those with an appropriate transfer (VAS score >8). Gender and transfer time (7 pm-7 am vs7 am-7 pm) did not have any influence on the transfer appropriateness.
Conclusions: Patients transferred directly to the orthopaedic service were statistically less likely to be appropriate transfers, travel via air, require other subspecialty consults, and require ICU care. Inappropriate transfers were more likely to be older, have poorer-paying insurance, and occur on weekends. 12.5% of transfers were deemed completely inappropriate by the accepting orthopaedic traumatologist.
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