Lindsey Lindsay J, Rasmussen Lindsey S, Hendrickson Landon S, Frech Emily S, Bozell Steven P, Stewart Kenneth E, Kennedy Ryan O, Cross Alisa, Albrecht Roxie M, Celii Amanda M
From the Department of Surgery (L.J.L., K.E.S., R.O.K., A.C., R.M.A., A.M.C.), University of Oklahoma Health Sciences Center; Trauma Program (L.S.R.), University of Oklahoma Medical Center, OU Health; and University of Oklahoma College of Medicine (L.S.H., E.S.F., S.P.B.), Oklahoma City, OK.
J Trauma Acute Care Surg. 2022 Apr 1;92(4):656-663. doi: 10.1097/TA.0000000000003505.
As the only Level I trauma center in the state, our hospital has seen an increase in the number of traumas requiring transfer for a higher level of care, placing strain on an already strained health care system. Traumas that are transferred to our facility and subsequently discharged back home indicate a subset of patients who may not be appropriate to transfer. The aim of this study is to identify commonalities between patients who were transferred for a higher level of care but do not require inpatient status and to assess patients who may benefit from a telemedicine evaluation.
A 2-year retrospective review of a prospective collected database of patients who were discharged from the ED following transfer to a Level I trauma center was conducted. Data included demographics, injuries, transferring facility, method of transport, activation criteria and level, additional imaging, consulting services, procedures, and disposition.
A total of 2,350 patients were transferred. Of those, 27% (632/2,350) were discharged home directly from the trauma bay. Of those patients, 36% (230/632) required complex bedside intervention or subspecialty consultation prior to discharge including complex laceration repairs 53%, ophthalmology examination 24%, splinting 18%, and joint reduction 5%. Sixty-four percent (402/632) of patients did not require complex bedside procedures prior to discharge. One hundred twenty hospitals transferred patients to our center during this period. The top 10 transferring facilities accounted for 40% (948/2,350) of our transfer volume.
Our study demonstrates that patients who are transferred to our facility and subsequently discharged have a common pattern of injuries; typically, isolated hand and face/ophthalmology. This is likely attributed to the lack of resources in rural facilities to evaluate and develop treatment plans for these injuries; however, only 36% of discharged patients required a bedside procedure. Excluding Level I traumas, head and spine injuries, and patients requiring complex bedside procedures, there was a 13% inappropriate rate of transfer (310/2,350). Development and implementation of a telemedicine system could potentially reduce the transfer and ED discharge rate, thereby improving efficiency and allowing for reallocation of resources as appropriate.
Prognostic and Epidemiologic, Level III.
作为该州唯一的一级创伤中心，我院接收的需要转至上级医疗机构接受更高水平治疗的创伤患者数量有所增加，这给本就不堪重负的医疗系统带来了压力。转至我院并随后出院的创伤患者表明，这部分患者可能并不适合转院。本研究的目的是确定那些转至上级医疗机构接受更高水平治疗但无需住院的患者之间的共性，并评估可能从远程医疗评估中受益的患者。
对前瞻性收集的转至一级创伤中心后从急诊科出院的患者数据库进行了为期2年的回顾性研究。数据包括人口统计学信息、损伤情况、转诊机构、运输方式、启动标准及级别、额外的影像学检查、会诊服务、操作及处置情况。
共2350例患者被转至我院。其中，27%（632/2350）的患者直接从创伤病房出院回家。在这些患者中，36%（230/632）在出院前需要进行复杂的床边干预或专科会诊，其中包括复杂裂伤修复53%、眼科检查24%、夹板固定18%以及关节复位5%。64%（402/632）的患者在出院前不需要进行复杂的床边操作。在此期间，有120家医院将患者转至我院。排名前十的转诊机构占我院转诊量的40%（948/2350）。
我们的研究表明，转至我院并随后出院的患者具有共同的损伤模式；通常为孤立的手部和面部/眼科损伤。这可能归因于农村医疗机构缺乏评估和制定这些损伤治疗方案的资源；然而，只有36%的出院患者需要床边操作。排除一级创伤、头部和脊柱损伤以及需要复杂床边操作的患者，转院不当率为13%（310/2350）。开发并实施远程医疗系统可能会降低转院率和急诊科出院率，从而提高效率，并允许合理重新分配资源。
预后与流行病学，三级。
