Direct admission to improve timely access to care for patients requiring transfer to a level 1 trauma center. Issue 1 (30th December 2020)

• Record Type: Journal Article
• Authors: Safavi, Kyan C; Gaitanidis, Apostolos; Breen, Kerry; Seelen, Mark; Raja, Ali; Velmahos, George C; Dunn, Peter F
• Is Part Of: Trauma surgery & acute care open. Volume 5:Issue 1(2020)
• Publication Date: 2020-12-30
• Subjects: healthcare quality -- access -- and evaluation -- multiple trauma -- emergency treatment; Traumatology -- Periodicals; Critical care medicine -- Periodicals; Wounds and injuries -- Periodicals; 617.1
• DOI: 10.1136/tsaco-2020-000607
• Languages: English
• ISSNs: 2397-5776

Abstract

Abstract : Background: Emergency departments (EDs) at level 1 trauma centers are often overcrowded and deny ED-to-ED transfers from lower-tiered centers. Lack of access to timely level 1 care is associated with increased mortality. We evaluated the feasibility of a direct admission (DA) protocol as a method to increase timely access to a level 1 trauma center during periods of ED overcrowding. Methods: During periods of ED overcrowding between 1 May and 31 December 2019, we admitted patients from referring EDs directly to the intensive care unit (ICU) or inpatient ward using the DA protocol. In a prospective comparative study design, we compared their outcomes to patients during the same period who were admitted through the ED when the ED was not overcrowded. Results: During periods of ED overcrowding, transfer was requested and clinically accepted for 28 patients, of which 23 (82.1%, age 63±20.3 years, men 52.2% men) were successfully admitted via the DA protocol. Five (17.9%) were not successfully transferred due to lack of available inpatient beds. During periods when the ED was not overcrowded, 106 patients (age 62.8±23.1 years, men 52.8%) were admitted via the ED. There were no morbidity or mortality events attributed to the DA process. Time to patient arrival was 2.7 hours (95% CI 2.3 to 3.1) in the DA cohort and 1.9 hours (95% CI 1.5 to 2.4) in the ED-to-ED cohort (p=0.104). Up-triage to the ICU within 24 hours was performed in only one patient (4.3%). In-hospital mortality did not differ (3 (13%) vs. 8 (7.6%), p=0.392). Discussion: The DA pathway is a feasible method to safely transfer patients from a referring ED to a higher-care trauma center when its ED is overcrowded. Level of evidence: Level III, care management.