Transferring patients to a pediatric trauma center: The transferring hospital’s perspective

Abstract

The rationale behind a regionalized trauma system is that patient outcomes are improved when trauma patients are rapidly transported to facilities with the level of expertise need to treat their injury. Functioning as an adult Level II trauma center, we wanted to know how the transfer process worked for pediatric patients whom we transfer to a Level I pediatric trauma center, which is part of the same multihospital system. Complete information on time of arrival, the time the transfer was accepted, and patient departure time were available for 116 patients (72% of pediatric patients transferred) for the period of January 1, 1997 through June 30, 1998. Patients were retrospectively stratified into two priority groups representing differing transport priority, based on use of a nasogastric tube, endotracheal tube or Foley catheter. Means for decision time and total time in transferring hospital were inspected. Decision time was 44 minutes (standard error 4.5 minutes) for priority patients and 92 minutes (11.5) for non-priority patients (t = 2.94, df = 114, P = 0.004). Total time for priority patients was 129 minutes (7.6) and 197 minutes (14.0) for non-priority patients (t = 3.37, df = 114, P = 0.001). Decision time was not influenced by extensive injury assessment or secondary studies. On average, pediatric patients spent nearly three hours in our facility. Our data indicate that a shorter decision time did not necessarily result in a reduction in wait time. Improving pediatric transfer times requires attention not only to injury assessment processes at the transferring facility and interhospital communications but also mobilization, hand-over, and any space or personnel constraints at the receiving pediatric facility.

Interhospital Transfer Occurs More Slowly for Elderly Acute Trauma Patients

“…Previous studies of transferred trauma patients have found shorter intervals than we found, with the time from presentation at the referring hospital until transfer request ranging from 62 to 78 min and the time spent at the referring hospital taking 182 min (17)(18)(19)(20)(21). Differences among these results underscore the inherent variability of the interhospital transfer process in different trauma systems.…”

Challenges in arranging interhospital transfer from a non‐tertiary hospital emergency department in the Perth metropolitan area

“…In Australia, system inefficiencies have been associated with delayed transfer that result in longer ED length of stay (LOS) and increased workloads when arranging an IHT . Similar issues have also been noted elsewhere . However, few studies have examined process issues when arranging IHT, particularly from the perspective of the referring hospital ED.…”

“…1 Similar issues have also been noted else-where. 3,4 However, few studies have examined process issues when arranging IHT, particularly from the perspective of the referring hospital ED.…”

Discordance Between Patient and Clinician Experiences and Priorities in Rural Interhospital Transfer: A Mixed Methods Study

“…12 Transfer is not without risks, and inadequate handoff communication, poor selection for transfer, transport risk, and cost all threaten to diminish the benefits if transfer is applied indiscriminately. [13][14][15] Patients cite significant concerns with the transfer process and report that interhospital transfer can be unpredictable, scary, confusing, and stressful. 16,17 Furthermore, some physician opinions regarding patient preferences are discordant with patients' selfreported preferences.…”

“…Objective patient outcomes are improved in high‐volume regional centers supported by networks targeting specific diseases, but some conditions still suffer from overtriage . Transfer is not without risks, and inadequate handoff communication, poor selection for transfer, transport risk, and cost all threaten to diminish the benefits if transfer is applied indiscriminately . Patients cite significant concerns with the transfer process and report that interhospital transfer can be unpredictable, scary, confusing, and stressful …”