Most Trauma Patients Not Transferred Within Mandated Time Frame in Illinois
MONDAY Dec. 20, 2010 -- Most trauma patients transferred between facilities in the state of Illinois don't make it to their final destination within the two hours mandated by the state.
But the most severely injured patients did make it within the time window, suggesting that physicians are appropriately triaging patients, according to a study in the December issue of the Archives of Surgery.
"If you didn't get there within two hours, it really didn't make any difference in markers of severity," said study co-author Dr. Thomas J. Esposito, chief of the division of trauma, surgical critical care and burns in the department of surgery at Loyola University Chicago Stritch School of Medicine in Maywood, Ill. "If left to their own devices, doctors may not need onerous advice on what to do."
"The [directive] is arbitrary and . . . probably doesn't matter in that the sickest people are being recognized and [transferred] more quickly," added Dr. Mark Gestring, medical director of the Strong Regional Trauma Center at the University of Rochester Medical Center. "The process is driven by how sick the patients are, and the truly sick patients are making the trip in enough time."
In fact, Esposito stated, there may be a downside to having such a rule.
"It sets up a situation in that someone can say you were supposed to get my loved one or my client here in two hours and that didn't happen . . . I'm looking for some compensation because you were out of compliance," he said.
And it may even overwhelm trauma centers with patients that don't really need to be there.
When patients are injured, they may not be near a hospital or trauma center that can help them, so are treated initially either at a local hospital, by emergency medical technicians or both.
"That [first] hospital can't finish the job, then the patient needs to move on after life-threatening conditions are dealt with," Esposito explained. After patients are stabilized, they can be moved to another facility which has, for example, a neurosurgeon to deal with that particular injury.
"Trauma centers provide certain kinds of care that are not available everywhere and to get the right patient to the trauma center is important, and keeping healthy people away is really important, too, because you don't want to overrun that particular resource and fly them from 50 or 100 miles away," Gestring said.
The authors reviewed information from the Illinois state trauma registry, which includes data from 64 trauma centers in the state, for the years 1999 through 2003.
They found 22,447 cases where patients had been transferred between facilities; information on timing was available in just over half of these.
Only 4,502 patients being transferred, or 20 percent, made it to their final destination within the prescribed two hours, although the median transfer time was really not that much higher: 2 hours and 21 minutes.
Those who did make it within the two-hour window were the most severely injured, indicating that trauma professionals were making the right decisions when triaging patients. These patients were also more likely to die, likely a reflection of how seriously they were injured.
Transferring patients is actually a fairly complicated process, with many variables playing into how fast the job gets done.
For instance, professionals have to decide how the transfer is going to happen, via ambulance or helicopter.
"If it's an ambulance, you might have deserts and mountains to deal with," Gestring said. "If it snows, helicopters are not particularly helpful."
Needless to say, many of these factors just aren't under the control of EMTs and doctors.
"I think the directive needs to be modified to something as generic as 'in an expeditious fashion' or 'in an appropriate timely fashion,'" Esposito said. "You've got to give the physician a little bit of credit to figure out who's sick or not sick."
The American College of Surgeons has a list of trauma centers in the United States.
Posted: December 2010