Durham, N.C. From the Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, and the Department of Orthopedics, Hand, and Upper Extremity Section, Duke University.
Plast Reconstr Surg. 2014 Apr;133(4):842-848. doi: 10.1097/PRS.0000000000000017.
The transfer of patients with hand injuries involves a commitment of substantial resources, emphasizing the importance of understanding factors that may influence referral patterns. Anecdotal experience suggests that the likelihood of transfer increases during nights and weekends. This study aimed to analyze patterns of hand trauma transfers to Duke University Medical Center with respect to timing and patient insurance status.
The authors performed a retrospective chart review and analysis of 1147 consecutive patient transfers from 2005 to 2010 at a single level 1 university trauma center. Data categories included timing of transfer, patient demographics, insurance status, diagnosis, and procedures performed. Statistical analysis was performed using SAS software (SAS Institute Inc., Cary, N.C.).
Of the patient sample, 39.8 percent was female, 30 percent were African American, and 57.3 percent were white. Contrary to our expectations, transfers were more likely during the day (p = 0.0001). Likewise, patients were more likely to present on weekdays than on weekends (p = .001). Although uninsured patients were not disproportionately represented overall, they were more frequently transferred at night (p = 0.0001), despite having the same complexity of injuries as privately insured patients. Conversely, patients with private insurance were less likely to be transferred at night (p = 0.0001).
Similar to studies in other surgical specialties, this analysis demonstrates significant associations between insurance status and hand injury transfer patterns. The current climate, including declining numbers of surgeons willing to provide emergency hand care, diminishing reimbursements, and an expanding uninsured patient population, threatens to exacerbate these concerning trends in trauma patient management.
手部损伤患者的转移需要投入大量资源，这凸显了了解可能影响转诊模式的因素的重要性。一些经验表明，夜间和周末转移的可能性增加。本研究旨在分析向杜克大学医学中心转诊手部创伤患者的模式，具体涉及时间和患者保险状况。
作者对 2005 年至 2010 年期间在一家单一的 1 级大学创伤中心连续转诊的 1147 例患者进行了回顾性图表审查和分析。数据类别包括转移时间、患者人口统计学特征、保险状况、诊断和所进行的手术。使用 SAS 软件（SAS Institute Inc.，Cary，NC）进行统计分析。
在患者样本中，39.8%为女性，30%为非裔美国人，57.3%为白人。与我们的预期相反，日间转移的可能性更大（p = 0.0001）。同样，患者更有可能在工作日而不是周末就诊（p = 0.001）。尽管总体上未保险患者的比例没有不成比例，但他们夜间更频繁地被转移（p = 0.0001），尽管他们的受伤复杂性与私人保险患者相同。相反，私人保险患者夜间更不可能被转移（p = 0.0001）。
与其他外科专业的研究类似，本分析表明保险状况与手部损伤转移模式之间存在显著关联。当前的形势，包括愿意提供紧急手部护理的外科医生人数减少、报销减少以及未参保患者人数增加，有可能加剧创伤患者管理中这些令人担忧的趋势。
