Putnam Jill, Pedreira Rachel, Fox Paige
Stanford University School of Medicine, Division of Plastic and Reconstructive Surgery, Stanford, Calif.
Plast Reconstr Surg Glob Open. 2020 Dec 22;8(12):e3279. doi: 10.1097/GOX.0000000000003279. eCollection 2020 Dec.
We hypothesize that some costly patient transfers to a level 1 trauma center for hand specialist management may be unnecessary. This analysis evaluates transfer cost effectiveness and whether time of consult, transfer distance, diagnosis at time of transfer, and provider level influence diagnostic accuracy and transport method.
Two hundred and sixty-five patients transferred to a suburban level 1 trauma center for hand surgeon evaluation between 2014 and 2019 were evaluated for patient and injury characteristics, time of consult, transfer distance, provider level, transport method, treatment cost, and diagnostic accuracy.
The average patient age was 36.2 years, and 80.3% were men. 21% of transfers had inaccurate pre-transfer diagnoses, and certain pre-transfer diagnoses correlated with an increased likelihood of inaccuracy, including flexor tenosynovitis and vascular injury. Patients with a language barrier had a greater likelihood of being transferred with an inaccurate diagnosis ( < 0.05). Compared with ground transport, air ambulance was associated with a higher cost of treatment ($225,679 versus $133,887, < 0.00001). Of all transfers, 14 (5%) were discharged from the emergency department (ED) without a procedure, 9 (3%) were admitted for observation, 73 (27%) had an ED procedure before discharge, and 166 (62%) received operative management.
Over 30% of transfers to a level 1 trauma center likely could have been managed at the transferring facility at a decreased cost. Certain diagnoses are associated with increased risk for diagnostic error and unnecessarily urgent transport. Providers can use this information to consider transfer patterns and to educate transferring providers.
我们假设，一些将患者转至一级创伤中心由手部专科医生进行治疗的高昂费用可能是不必要的。本分析评估了转运的成本效益，以及会诊时间、转运距离、转运时的诊断结果和医疗服务提供者级别是否会影响诊断准确性和转运方式。
对2014年至2019年间转至一家郊区一级创伤中心接受手外科医生评估的265例患者的患者及损伤特征、会诊时间、转运距离、医疗服务提供者级别、转运方式、治疗费用和诊断准确性进行了评估。
患者平均年龄为36.2岁，80.3%为男性。21%的转运患者在转运前诊断不准确，某些转运前诊断与诊断不准确的可能性增加相关，包括屈指肌腱腱鞘炎和血管损伤。有语言障碍的患者在转运时诊断不准确的可能性更大（<0.05）。与地面转运相比，空中救护车的治疗费用更高（225,679美元对133,887美元，<0.00001）。在所有转运患者中，14例（5%）在急诊科（ED）未接受手术就出院了，9例（3%）入院观察，73例（27%）在出院前在急诊科接受了手术，166例（62%）接受了手术治疗。
超过30%转至一级创伤中心的患者可能在转诊机构得到治疗，且费用会降低。某些诊断与诊断错误风险增加和不必要的紧急转运相关。医疗服务提供者可利用这些信息来考虑转运模式，并对转诊的医疗服务提供者进行培训。
