Trauma transfers discharged from the emergency department—Is there a role for telemedicine?. Issue 4 (20th April 2022)

• Record Type: Journal Article
• Authors: Lindsey, Lindsay J.; Rasmussen, Lindsey S.; Hendrickson, Landon S.; Frech, Emily S.; Bozell, Steven P.; Stewart, Kenneth E.; Kennedy, Ryan O.; Cross, Alisa; Albrecht, Roxie M.; Celii, Amanda M.
• Is Part Of: Journal of trauma and acute care surgery. Volume 92:Issue 4(2022)
• Page Start: 656
• Page End: 663
• Publication Date: 2022-04-20
• Subjects: Rural trauma -- telemedicine -- transfer -- trauma -- resources; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003505
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : Trauma patients transferred and subsequently discharged represent a group of patients that could benefit from a telemedicine consult and thereby avoid transfer. Common characteristics were identified to facilitate creation of a standardized protocol for telemedicine evaluation. Abstract : BACKGROUND: As the only Level I trauma center in the state, our hospital has seen an increase in the number of traumas requiring transfer for a higher level of care, placing strain on an already strained health care system. Traumas that are transferred to our facility and subsequently discharged back home indicate a subset of patients who may not be appropriate to transfer. The aim of this study is to identify commonalities between patients who were transferred for a higher level of care but do not require inpatient status and to assess patients who may benefit from a telemedicine evaluation. METHODS: A 2-year retrospective review of a prospective collected database of patients who were discharged from the ED following transfer to a Level I trauma center was conducted. Data included demographics, injuries, transferring facility, method of transport, activation criteria and level, additional imaging, consulting services, procedures, and disposition. RESULTS: A total of 2, 350 patients were transferred. Of those, 27% (632/2, 350) were discharged home directly from the trauma bay. Of those patients, 36% (230/632) required complex bedside intervention or subspecialty consultation prior to discharge including complex laceration repairs 53%, ophthalmology examination 24%, splinting 18%, and joint reduction 5%. Sixty-four percent (402/632) of patients did not require complex bedside procedures prior to discharge. One hundred twenty hospitals transferred patients to our center during this period. The top 10 transferring facilities accounted for 40% (948/2, 350) of our transfer volume. CONCLUSION: Our study demonstrates that patients who are transferred to our facility and subsequently discharged have a common pattern of injuries; typically, isolated hand and face/ophthalmology. This is likely attributed to the lack of resources in rural facilities to evaluate and develop treatment plans for these injuries; however, only 36% of discharged patients required a bedside procedure. Excluding Level I traumas, head and spine injuries, and patients requiring complex bedside procedures, there was a 13% inappropriate rate of transfer (310/2, 350). Development and implementation of a telemedicine system could potentially reduce the transfer and ED discharge rate, thereby improving efficiency and allowing for reallocation of resources as appropriate. LEVEL OF EVIDENCE: Prognostic and Epidemiologic, Level III. Abstract :