It is (not) always on Friday: inter-hospital patient transfers in orthopedic and trauma surgery

Abstract

Background While inter-hospital transfers for patients who have suffered major trauma have been well investigated, patient flows for other injured patients, or cases with orthopedic complications, are rarely described. This study aims to analyze the affected collective and to show possible reasons, patterns, and pitfalls to optimize the process in future. Materials and methods In a prospective cohort study, all consecutive transfers to a Level I trauma center in Germany were documented and assessed. Patients suffering a major trauma were excluded. Data on the primary treating hospital, patient characteristics, and differences between emergency and elective surgery were analyzed. Results A total of 227 patients were included; 162 were injured, while 65 had suffered a complication after elective orthopedic surgery or had a complex orthopedic pathology. The most common diagnoses leading to transfer were pathologies of the extremities (n = 62), pathologies of the spine (n = 50), and infections (n = 18). The main reasons stated by the transferring hospitals were a lack of expertise (137 cases) and a lack of capacity (43 cases). There was a significantly higher rate of transfers due to trauma (n = 162) than for orthopedic patients (n = 65), p < 0.0001. Conclusion There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery.

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany

“…Regulations and guidelines for the treatment of complex disease patterns could certainly help to improve the care situation. So far, these do not exist in the care of orthopedic and trauma surgery patients, just as there are no clear recommendations and procedures on which patients should be transferred [ 15 ].…”

“…This takes time and delays further treatment. So far, there is no standardized protocol for these transfers [ 15 ].…”