Robert S O'Connell1, Emanuel C Haug2, Pramote Malasitt3, Satya Mallu4, Jibanananda Satpathy1, Jonathan Isaacs5, Varatharaj Mounasamy6. 1. Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA, 23298-0153, USA. 2. Department of Orthopaedic Surgery, University of Virginia, 400 Ray C Hunt Dr, Charlottesville, VA, 22903, USA. 3. Department of Orthopaedic Surgery, Emory University, 57 Executive Park South, Suite 160-3, Atlanta, GA, 30329, USA. 4. Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University, 1217 E. Marshall St., P.O. Box 121722, Richmond, VA, 23298, USA. 5. Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA, 23298-0153, USA. 6. Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, VA, 23298-0153, USA. varatharaj.mounasamy@vcuhealth.org.
Abstract
BACKGROUND: Trauma patients are frequently transferred to a higher level of care for specialized orthopedic care. Many of these transfers are not necessary and waste valuable resources. The purpose of this study was to quantify our own experience and to assess the appropriateness of orthopedic transfers to a level I trauma center emergency department. METHODS: A retrospective review of orthopedic emergency department transfers to a level I trauma center was performed. Data collected included time of transfer, injury severity score (ISS), age, gender, race, orthopedic coverage at transfer institution, and insurance status. Two orthopedic trauma surgeons graded the appropriateness of transfer. A weighted logistic regression model was used to compare dependent and independent variables. RESULTS: A total of 324 patient transfers were reviewed; 65 (20.1%) of them were graded as inappropriate. There was no statistically significant relationship between appropriateness of transfer and age, availability of orthopedic coverage, night/weekend transfer, or insurance status. Regression analysis showed that only ISS (OR 1.130, p = .008) and "polytrauma" (OR 25.39, p < .0001) designation were associated with increased odds ratio of appropriate transfer. The kappa coefficient for inter-rater reliability between the two raters was 0.505 (95% CI, 0.388-0.623) reflecting moderate agreement. CONCLUSION: Inappropriate transfers create a significant medical burden to our health care system using valuable resources. Our study found similar results of inappropriate transfers compared to previous studies. However, we did not find a relationship between insurance status or nights/weekends and transfer appropriateness.
BACKGROUND:Traumapatients are frequently transferred to a higher level of care for specialized orthopedic care. Many of these transfers are not necessary and waste valuable resources. The purpose of this study was to quantify our own experience and to assess the appropriateness of orthopedic transfers to a level I trauma center emergency department. METHODS: A retrospective review of orthopedic emergency department transfers to a level I trauma center was performed. Data collected included time of transfer, injury severity score (ISS), age, gender, race, orthopedic coverage at transfer institution, and insurance status. Two orthopedic trauma surgeons graded the appropriateness of transfer. A weighted logistic regression model was used to compare dependent and independent variables. RESULTS: A total of 324 patient transfers were reviewed; 65 (20.1%) of them were graded as inappropriate. There was no statistically significant relationship between appropriateness of transfer and age, availability of orthopedic coverage, night/weekend transfer, or insurance status. Regression analysis showed that only ISS (OR 1.130, p = .008) and "polytrauma" (OR 25.39, p < .0001) designation were associated with increased odds ratio of appropriate transfer. The kappa coefficient for inter-rater reliability between the two raters was 0.505 (95% CI, 0.388-0.623) reflecting moderate agreement. CONCLUSION: Inappropriate transfers create a significant medical burden to our health care system using valuable resources. Our study found similar results of inappropriate transfers compared to previous studies. However, we did not find a relationship between insurance status or nights/weekends and transfer appropriateness.
Entities:
Keywords:
Appropriateness; Transfer; Trauma center
Authors: Bedabrata Sarkar; Melissa E Brunsvold; Jill R Cherry-Bukoweic; Mark R Hemmila; Pauline K Park; Krishnan Raghavendran; Wendy L Wahl; Stewart C Wang; Lena M Napolitano Journal: J Trauma Date: 2011-11
Authors: Emanuel C Haug; Hakan Pehlivan; J Ryan Macdonell; Wendy Novicoff; James Browne; Thomas Brown; Quanjun Cui Journal: World J Orthop Date: 2022-08-18