It is (not) Always on Friday: Inter-hospital Patient Transfers in Orthopedic and Trauma Surgery

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2023 Aug 20

PMID 37599307

Authors

Jonas Roos

Thomas Loy

Milena M Ploeger

Leonie Weinhold

Matthias Schmid

Moritz Mewes

Christian Prangenberg

Martin Gathen

Affiliations

Soon will be listed here.

Abstract

Background: While inter-hospital transfers for patients who have suffered major trauma have been well investigated, patient flows for other injured patients, or cases with orthopedic complications, are rarely described. This study aims to analyze the affected collective and to show possible reasons, patterns, and pitfalls to optimize the process in future.

Materials And Methods: In a prospective cohort study, all consecutive transfers to a Level I trauma center in Germany were documented and assessed. Patients suffering a major trauma were excluded. Data on the primary treating hospital, patient characteristics, and differences between emergency and elective surgery were analyzed.

Results: A total of 227 patients were included; 162 were injured, while 65 had suffered a complication after elective orthopedic surgery or had a complex orthopedic pathology. The most common diagnoses leading to transfer were pathologies of the extremities (n = 62), pathologies of the spine (n = 50), and infections (n = 18). The main reasons stated by the transferring hospitals were a lack of expertise (137 cases) and a lack of capacity (43 cases). There was a significantly higher rate of transfers due to trauma (n = 162) than for orthopedic patients (n = 65), p < 0.0001.

Conclusion: There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery.

Citing Articles

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany.

Roos J, Ben Amar S, Weinhold L, Zellner A, Touet A, Prangenberg C Clin Pract. 2024; 14(3):789-800.

PMID: 38804395 PMC: 11130787. DOI: 10.3390/clinpract14030063.

References

Sethi D, Subramanian S . When place and time matter: How to conduct safe inter-hospital transfer of patients. Saudi J Anaesth. 2014; 8(1):104-13. PMC: 3950432. DOI: 10.4103/1658-354X.125964. View

Tang A, Hashmi A, Pandit V, Joseph B, Kulvatunyou N, Vercruysse G . A critical analysis of secondary overtriage to a Level I trauma center. J Trauma Acute Care Surg. 2014; 77(6):969-73. DOI: 10.1097/TA.0000000000000462. View

Samland M . . Z Orthop Unfall. 2022; 160(6):616-617. DOI: 10.1055/a-1483-0132. View

Ernstberger A, Koller M, Zeman F, Kerschbaum M, Hilber F, Diepold E . A trauma network with centralized and local health care structures: Evaluating the effectiveness of the first certified Trauma Network of the German Society of Trauma Surgery. PLoS One. 2018; 13(3):e0194292. PMC: 5851627. DOI: 10.1371/journal.pone.0194292. View

McCullough A, Haycock J, Forward D, Moran C . II. Major trauma networks in England. Br J Anaesth. 2014; 113(2):202-6. DOI: 10.1093/bja/aeu204. View

Frink M, Kuhne C, Debus F, Pries A, Ruchholtz S . [The TraumaNetzwerk DGU project. Goals, conception, and successes achieved]. Unfallchirurg. 2013; 116(1):61-71. DOI: 10.1007/s00113-012-2326-5. View

Sampalis J, Denis R, FRECHETTE P, Brown R, Fleiszer D, Mulder D . Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. J Trauma. 1997; 43(2):288-95; discussion 295-6. DOI: 10.1097/00005373-199708000-00014. View

Hamprecht A, Rohde A, Behnke M, Feihl S, Gastmeier P, Gebhardt F . Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors. J Antimicrob Chemother. 2016; 71(10):2957-63. DOI: 10.1093/jac/dkw216. View

Crichlow R, Zeni A, Reveal G, Kuhl M, Heisler J, Kaehr D . Appropriateness of patient transfer with associated orthopaedic injuries to a Level I trauma center. J Orthop Trauma. 2010; 24(6):331-5. DOI: 10.1097/BOT.0b013e3181ddfde9. View

10.

Schoettker P, DAmours S, Nocera N, Caldwell E, Sugrue M . Reduction of time to definitive care in trauma patients: effectiveness of a new checklist system. Injury. 2003; 34(3):187-90. DOI: 10.1016/s0020-1383(02)00280-2. View

11.

Hill A, Fowler R, Nathens A . Impact of interhospital transfer on outcomes for trauma patients: a systematic review. J Trauma. 2011; 71(6):1885-900. DOI: 10.1097/TA.0b013e31823ac642. View

12.

Chiara O, Cimbanassi S . Organized trauma care: does volume matter and do trauma centers save lives?. Curr Opin Crit Care. 2003; 9(6):510-4. DOI: 10.1097/00075198-200312000-00008. View

13.

Sorensen M, von Recklinghausen F, Fulton G, Burchard K . Secondary overtriage: the burden of unnecessary interfacility transfers in a rural trauma system. JAMA Surg. 2013; 148(8):763-8. DOI: 10.1001/jamasurg.2013.2132. View

14.

Mueller S, Zheng J, Orav E, Schnipper J . Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation. J Hosp Med. 2017; 12(6):435-442. PMC: 11096839. DOI: 10.12788/jhm.2747. View

15.

Chwals W, Robinson A, Sivit C, Alaedeen D, Fitzenrider E, Cizmar L . Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure. J Pediatr Surg. 2008; 43(12):2268-72. DOI: 10.1016/j.jpedsurg.2008.08.061. View

16.

Watson J . The dilemma of appropriate vs. inappropriate hospital transfers. J Orthop Trauma. 2010; 24(6):342-3. DOI: 10.1097/BOT.0b013e3181ddfaa4. View

17.

Mamczak C, Streubel P, Gardner M, Ricci W . Unravelling the debate over orthopaedic trauma transfers: The sender's perspective. Injury. 2013; 44(12):1832-7. DOI: 10.1016/j.injury.2013.03.035. View

18.

Thakur N, Plante M, Kayiaros S, Reinert S, Ehrlich M . Inappropriate transfer of patients with orthopaedic injuries to a Level I trauma center: a prospective study. J Orthop Trauma. 2010; 24(6):336-9. DOI: 10.1097/BOT.0b013e3181b18b89. View

19.

Pickering A, Cooper K, Harnan S, Sutton A, Mason S, Nicholl J . Impact of prehospital transfer strategies in major trauma and head injury: systematic review, meta-analysis, and recommendations for study design. J Trauma Acute Care Surg. 2014; 78(1):164-77. DOI: 10.1097/TA.0000000000000483. View

20.

Waalwijk J, Lokerman R, van der Sluijs R, Fiddelers A, Den Hartog D, Leenen L . The influence of inter-hospital transfers on mortality in severely injured patients. Eur J Trauma Emerg Surg. 2022; 49(1):441-449. PMC: 9925487. DOI: 10.1007/s00068-022-02087-7. View