Abstract
Background
In many rural trauma systems injured patients are initially evaluated at a local hospital,
and once stabilized transferred to a trauma center for definitive care. In the U.S.
most trauma transfers occur as emergency department (ED) to ED transfers, however
there is little evidence to guide systems in whether this is beneficial. We implemented
a practice change in August 2018, changing from commonly admitting trauma transfers
directly to the floor, to a protocol for ED to ED transfer for all trauma patients.
We aimed to evaluate this practice change and its effects on outcomes and ED length
of stay.
Methods
We retrospectively reviewed all trauma transfers to our Level 1 trauma center between
8/1/2017–8/30/2020. Study groups were created based on the presence of a transfer
protocol: a control group with no protocol, a selective ED pitstop protocol group
and a systemwide ED pitstop protocol group. We compared patient and injury factors
between groups, and evaluated each group's hospital mortality, unplanned ICU admission
within 24 h, need for return to radiology for imaging, and ED length of stay.
Results
1,987 patients were transferred during the study period. In our control group 37%
of transfers were directly admitted. Implementing a selective ED pitstop decreased
direct admissions to 17% and a systemwide ED pitstop decreased direct admissions to
10%. There was no difference in mortality between groups. Protocol implementation
decreased unplanned ICU admissions from 2% to 1% in the selective protocol and 0.8%
in the systemwide protocol, as well as decreasing the need for further diagnostic
imaging (5% to 2.5% and 2%; in each group respectively). ED length of stay was not
different between time periods.
Conclusions
Implementing an ED pitstop protocol for trauma transfers led to decreased direct admissions,
without increasing the ED length of stay, and less need for delayed imaging.
Keywords
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Article info
Publication history
Published online: August 28, 2022
Accepted:
August 23,
2022
Footnotes
All authors have no conflicts of interest to disclose.
No funding received for this work.
The authors would like to acknowledge Kielo Evjen for her assistance in this project.
This paper was presented at the Trauma Quality Improvement Program (TQIP) 202 Annual Scientific Meeting.
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
