Up to one-third of patients with critical injuries are first taken to the closest non-trauma-specialized hospital before being transferred to a higher-level trauma center. But these transfers can take hours and lead to preventable deaths, a recent study found.
The study, led by Chicago-based Northwestern Medicine and published in Annals of Surgery, analyzed transfers at nine high-level adult trauma centers and three high-level pediatric trauma centers. It used failure modes effects analysis to identify and rate failures in the transfer process and calculate each center's risk priority number. Researchers also talked to 64 healthcare workers involved in receiving transferred patients to determine the most urgent areas for improvement, according to a Jan. 9 Northwestern Medicine news release.
Researchers found a crucial need to improve interhospital transportation and communication of patient clinical information. Improving coordination between hospitals would require increased access to critical care ambulances, training of transport staff and new mechanisms to exchange information, such as radiology scans and estimated arrival times.
Another Northwestern study found that non-trauma and lower-level trauma hospitals lacked clear and consistent criteria for which patients should be transferred, and also struggled to connect with higher-level trauma centers that would accept patients.
Northwestern researchers recommended one way hospitals can improve transfers: a bed tracker, such as the one the Chicago Department of Public Health required hospitals to update twice per day during the COVID-19 pandemic. The tracker used bed-capacity data directly from the EHR, which could be viewed on a shared dashboard.
"This is a way of saving lives that is within our reach for daily emergencies like traumatic injuries and heart attacks, as well as for the next pandemic or natural disaster," senior study author Anne Stey, MD, assistant professor of surgery in the division of trauma and critical care, and a Northwestern Medicine physician, said in the news release. "If hospitals are willing to collaborate more broadly around sharing the bed resources that they have available and prioritizing injured patients in particular, there is so much potential to save people from dying at small, non-trauma hospitals."