It is (not) always on Friday: inter-hospital patient transfers in orthopedic and trauma surgery.
Collective analysis
Inter-hospital transfers
Level I trauma center
Orthopedic complications
Patient flows
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
20 Aug 2023
20 Aug 2023
Historique:
received:
06
03
2023
accepted:
17
07
2023
medline:
21
8
2023
pubmed:
21
8
2023
entrez:
20
8
2023
Statut:
aheadofprint
Résumé
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. 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. 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. There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery.
Identifiants
pubmed: 37599307
doi: 10.1007/s00068-023-02335-4
pii: 10.1007/s00068-023-02335-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Ettl C. Personelle und infrastrukturelle Anforderungen an ein „Überregionales Traumazentrum“ steigen nach Etablierung des TraumaNetzwerk DGU® [Internet]. Universität Ulm; 2020 [cited 2022 Jul 18]. Available from: https://oparu.uni-ulm.de/xmlui/handle/123456789/25199
Mamczak CN, Streubel PN, Gardner MJ, Ricci WM. 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
pubmed: 23648363
Mueller S, Zheng J, Orav EJ, Schnipper JL. Inter-hospital transfer and patient outcomes: a retrospective cohort study. BMJ Qual Saf. 2019;28(11):e1–e1.
doi: 10.1136/bmjqs-2018-008087
pubmed: 30257883
Chwals WJ, Robinson AV, Sivit CJ, 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
pubmed: 19040950
Thakur NA, Plante MJ, Kayiaros S, Reinert SE, Ehrlich MG. 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
pubmed: 20502210
Goldfarb CA, Borrelli J, Lu M, Ricci WM. A prospective evaluation of patients with isolated orthopedic injuries transferred to a level I trauma center. J Orthop Trauma. 2006;20(9):613–7.
doi: 10.1097/01.bot.0000249415.47871.e5
pubmed: 17088663
Mueller SK, Zheng J, Orav EJ, Schnipper JL. Rates, predictors and variability of interhospital transfers: a national evaluation. J Hosp Med. 2017;12(6):435–42.
doi: 10.12788/jhm.2747
pubmed: 28574533
Barry PW, Ralston C. Adverse events occurring during interhospital transfer of the critically ill. Arch Dis Child. 1994;71(1):8–11.
doi: 10.1136/adc.71.1.8
pubmed: 8067799
pmcid: 1029903
Gray A, Bush S, Whiteley S. Secondary transport of the critically ill and injured adult. Emerg Med J. 2004;21(3):281–5.
doi: 10.1136/emj.2003.005975
pubmed: 15107363
pmcid: 1726322
Frink M, Kühne C, Debus F, Pries A, Ruchholtz S. The traumanetzwerk DGU project goals, conception, and successes achieved. Unfallchirurg. 2013;116(1):61–71 (quiz 72–3).
doi: 10.1007/s00113-012-2326-5
pubmed: 23307433
McCullough AL, Haycock JC, Forward DP, Moran CG II. Major trauma networks in England. Br J Anaesth. 2014;113(2):202–6.
doi: 10.1093/bja/aeu204
pubmed: 25038152
Ernstberger A, Koller M, Zeman F, Kerschbaum M, Hilber F, Diepold E, et al. 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.
doi: 10.1371/journal.pone.0194292
pubmed: 29538456
pmcid: 5851627
Waalwijk JF, Lokerman RD, van der Sluijs R, Fiddelers AAA, den Hartog D, Leenen LPH, et al. The influence of inter-hospital transfers on mortality in severely injured patients. Eur J Trauma Emerg Surg. 2022. https://doi.org/10.1007/s00068-022-02087-7 .
doi: 10.1007/s00068-022-02087-7
pubmed: 36048180
pmcid: 9925487
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
pubmed: 14639071
Crichlow RJ, Zeni A, Reveal G, Kuhl M, Heisler J, Kaehr D, et al. 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
pubmed: 20502209
Hamprecht A, Rohde AM, Behnke M, Feihl S, Gastmeier P, Gebhardt F, et al. 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
pubmed: 27317445
Sampalis JS, Denis R, Fréchette 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 295-296).
doi: 10.1097/00005373-199708000-00014
pubmed: 9291375
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. 2015;78(1):164–77.
doi: 10.1097/TA.0000000000000483
pubmed: 25539218
Hill AD, Fowler RA, Nathens AB. Impact of interhospital transfer on outcomes for trauma patients: a systematic review. J Trauma. 2011;71(6):1885–900 (discussion 1901).
pubmed: 22182900
Sharma BR. Triage in trauma-care system: a forensic view. J Clin Forensic Med. 2005;12(2):64–73.
doi: 10.1016/j.jcfm.2005.01.006
pubmed: 15863020
Con J, Long D, Sasala E, Khan U, Knight J, Schaefer G, et al. Secondary overtriage in a statewide rural trauma system. J Surg Res. 2015;198(2):462–7.
doi: 10.1016/j.jss.2015.03.077
pubmed: 25959835
pmcid: 4568987
Tang A, Hashmi A, Pandit V, Joseph B, Kulvatunyou N, Vercruysse G, et al. 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
pubmed: 25423540
Sorensen MJ, von Recklinghausen FM, Fulton G, Burchard KW. 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
pubmed: 23784088
Watson JT. The dilemma of appropriate vs inappropriate hospital transfers. J Orthopaedic Trauma. 2010;24(6):342–3.
doi: 10.1097/BOT.0b013e3181ddfaa4
Samland M. Mitarbeitergewinnung, Mitarbeiterpflege und Mitarbeiterbindung: ein Appell. Z Orthop Unfall. 2022;160(06):616–7.
doi: 10.1055/a-1483-0132
pubmed: 36451609
Petzold T, Haase E, Niethard FU, Schmitt J. Orthopädisch-unfallchirurgische Versorgung bis 2050: analyse des Inanspruchnahmeverhaltens bei relevanten Erkrankungen und Ableitung der Häufigkeit ärztlicher Leistungserbringer. Orthopäde. 2016;45(2):167–73.
doi: 10.1007/s00132-015-3176-y
pubmed: 26432792
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.
doi: 10.4103/1658-354X.125964
pubmed: 24665250
pmcid: 3950432
Goh YC, Lam CK, Poon WSK. The impact of teleradiology on the inter-hospital transfer of neurosurgical patients. Br J Neurosurg. 1997;11(1):52–6.
doi: 10.1080/02688699746708
pubmed: 9156019
Schoettker P, D’Amours SK, 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
pubmed: 12623248