Rapid Discharge After Transfer: Risk Factors, Incidence, and Implications for Trauma Systems

Abstract

Secondary overtriage is more common in pediatric patients than in adults. The underlying causes of this occurrence need to be further investigated (e.g., fear of litigation and uneven distribution of resources). There are significant direct and indirect costs associated with these occurrences that must be considered as we identify areas of potential cost savings in our nation's health care.

Rural ED transfers due to lack of radiology services

“…When available, telemedicine provides remote access to radiology reading services in real time. Transmission of realtime US video via commercially available video mobile phones to an available ED physician is a possible way to reduce transfers [9]. This method would allow for a US technician from a Rural ED to be directly in contact with a remote physician who would be able to see the image in real-time and provide guidance to the technician.…”

Secondary Overtriage in Pediatric Trauma: Can Unnecessary Patient Transfers Be Avoided?

“…A review of existing triage literature demonstrated that severity of injury, need for surgical intervention, and hospital resources including intensive care units are common factors that affect facility determination [3,4,10,[12][13][14][15]. Additionally, length of stay after transfer has been previously utilized as an indicator of necessity for transfer.…”

“…National guidelines exist for primary triage, which recommend maintaining measurable primary overtriage rates to level I trauma centers in order to minimize missed injury [9]. However, secondary overtriage, or unnecessary patient transfer, is poorly characterized and lacks well-defined targets [10][11][12]. Secondary overtriage is a challenge to system resources, can delay definitive care, and can be costly or inconvenient for patients and their families [13].…”

Secondary overtriage in a statewide rural trauma system

“…These are potentially unnecessary transfers and an analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole. Few studies have addressed this phenomenon, with reported secondary overtriage rates between 39% and 6.9% [1, 9–11]. However, there has been little consensus in the methodologies and definitions for secondary overtriage.…”

“…Most studies have been from single institutions comparing the rate of secondary overtriage using the total number of incoming transfers to that institution as the denominator [1, 9, 10]. An exception to the single institution studies was one done by Osen, in which selected all transferred trauma patients form the National Inpatient Sample, and they found the secondary overtriage rate to be 6.9% [11]. The only similarity between these definitions for secondary overtriage was that they all used the transfer population as a denominator.…”