Which transfers can we avoid: Multi-state analysis of factors associated with discharge home without procedure after ED to ED transfer for traumatic injury - 24/04/18
Abstract |
Objective |
Among injured patients transferred from one emergency department (ED) to another, we determined factors associated with being discharged from the second ED without procedures, or admission or observation.
Methods |
We analyzed all patients with injury diagnosis codes transferred between two EDs in the 2011 Healthcare Utilization Project State Emergency Department and State Inpatient Databases for 6 states. Multivariable hierarchical logistic regression evaluated the association between patient (demographics and clinical characteristics) and hospital factors, and discharge from the second ED without coded procedures.
Results |
In 2011, there were a total of 48,160 ED-to-ED injury transfers, half of which (49%) were transferred to non-trauma centers, including 23% with major trauma. A total of 22,011 transfers went to a higher level of care, of which 36% were discharged from the ED without procedures. Relative to torso injuries, discharge without procedures was more likely for patients with soft tissue (OR 6.8, 95%CI 5.6–8.2), head (OR 3.7, 95%CI 3.1–4.6), facial (OR 3.8, 95%CI 3.1–4.7), or hand (OR 3.1, 95%CI 2.6–3.8) injuries. Other factors included Medicaid (OR 1.3, 95%CI 1.2–1.5) or uninsured (OR 1.3, 95%CI 1.2–1.5) status. Treatment at the receiving ED added an additional $2859 on average (95% CI $2750–$2968) per discharged patient to the total charges for injury care, not including the costs of ambulance transport between facilities.
Conclusion |
Over a third of patients transferred to another ED for traumatic injury are discharged from the second ED without admission, observation, or procedures. Telemedicine consultation with sub-specialists might reduce some of these transfers.
Le texte complet de cet article est disponible en PDF.Abbreviations : AHA, AIS, HCUP, ISS, SEDD, SID, TIEP
Keywords : Trauma, Health policy, Public health, Transfers
Plan
Vol 36 - N° 5
P. 797-803 - mai 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?