Clinical Medicine Insights: Trauma and Intensive Medicine

From the Department of Surgery, University of California, Davis, Medical Center, Sacramento, California (GHU, DHW) and the Department of Surgery, University of California, San Francisco, East Bay, Oakland, California (GPV).

Abstract

Background:  Trauma patients in rural areas are frequently transferred to regional trauma centers for expeditious evaluation and management of potentially life-threatening injuries. We sought to characterize how long the process takes, once it has begun, for acutely injured patients to be transferred from emergency departments (EDs) of referring hospitals to trauma centers and how the time is spent.

Methods:  We conducted a retrospective multi-institutional case series study. We reviewed records of acutely injured trauma patients transferred from the EDs of 114 outlying hospitals to the EDs of three Level I or II regional trauma centers over a 12–24 month period. We calculated the duration of the transfer process and its component time intervals (reported as the mean ± standard deviation).

Results:  Among 1099 patients transferred from 114 referring hospitals, the mean Injury Severity Score was 11.6. Mortality was 5.9%. Half of all transfers were by ground ambulance, 36% by helicopter, and 13% by airplane. The mean time from patient presentation at the ED of the referring hospital until transfer request was 126 ± 94 min, and the mean time from transfer acceptance until arrival at the trauma center was an additional 119 ± 60 min. The mean time from transfer acceptance to departure of the patient from the ED of the referring hospital was 68 ± 48 min. Transportation time accounted for 48 ± 29 min, or 40% of the total time between transfer acceptance and arrival at the accepting hospital.

Conclusions:  Interhospital transfer of acutely injured trauma patients takes a substantial amount of time even after acceptance of the patient, and actual time spent in transportation accounts for only 40% of the time from transfer acceptance to arrival of the patient at the receiving hospital, on average. Efforts to speed transfers should focus on shortening the time from transfer acceptance to departure from the referring hospital.