D. A. Mateo De Acosta1, R. Asfour1, M. Gutierrez1, S. Carrie2, J. Marshall2 1University Of Illinois College Of Medicine At Peoria (UICOMP),Department Of Surgery,Peoria, IL, USA 2University Of Illinois College Of Medicine At Peoria,Division Of Trauma / Department Of Surgery,Chicago, IL, USA
Introduction:
The goal of regional trauma systems is to deliver adequate level of care to injured patients in a timely and cost effective manner. Inter-facility transfer of injured patients is the foundation of the United States trauma systems. Patients are commonly secondarily overtriaged delaying their definitive care and posing unnecessary burden on the receiving institution. Secondary overtriage ranges from 6.9 – 38%. The financial burden of secondary overtriaging that is placed on receiving institutions has been rarely studied.
Methods:
We reviewed the EMR and trauma registry data of 1200 patients transferred to our institution due to traumatic injuries, during a three year period. Patients were divided in two groups. Group 1 included patients “secondarily overtriaged” and Group 2 (control) those appropriately triaged. Secondary overtriage was defined as patients transferred from another hospital emergency department to our trauma service with an injury severity score (ISS) < 10, did not require an operation, and were discharged home within 48 hours of admission.
Results:
We identified 399 adult patients secondarily overtriaged to our institution. These represented a 31.9% of those transferred to our institution during the study period. Common indications for transfer were trauma to the torso, neurological, facial or orthopedic trauma. Main reasons for transfer among those secondarily overtriaged were Traumatic Brain Injury (37.4%, p<0.05) and Orthopedic Trauma (21.8 %, p<0.05), impacted by the unavailability of speialist physcians in the reffering institution. Average hospital cost and reimbursement per overtriaged patient were $19,301 and $7,356.83 respectively. Cost itemization was as follows: Trauma activation – $5,016.49, Observation boarding $1,7413, Radiology – $ $4,339.09, Laboratory – $1,836.68, Pharmacy – $1,256.1 and Supplies – $2,431.6.Transport was by ground in 85.95% of patients and via helicopter in 14.05%. Average cost helicopter transport was $19.535.78.
Conclusion:
Secondary trauma overtriage presents a significant burden on trauma centers with an average cost per patient of approximately $19,301. Major reasons for transfer to our institution were traumatic brain injury and orthopedic mainly due to the unavailability of subspecialty services in the transferring institution. Education of rural trauma triage staff must continue to intensify in order to minimize the secondary overtriage of patients, expediting their care and optimizing resource utilization