Hand Injury and Pathology Transfers to a Single Tertiary Care Center
Michael Anderson, BS1, Nicholas Pilla, MD1, Brittany Homcha, MD1 and Kenneth Taylor, MD2, (1)Penn State College of Medicine, Hershey, PA, (2)Pennsylvania State University, Hershey, PA
INTRODUCTION: Injuries and conditions of the hand are common reasons for presentation to the emergency department (ED). However, many hospitals are not prepared to treat these often-complex injuries, resulting in transfers to other institutions. The objective of this study was to analyze patterns and disposition of hand pathology transfers to a single tertiary care center.
MATERIALS & METHODS: The inter-hospital transfer database was queried at a single Level I trauma center. A total of 1,636 transfers were retrospectively identified between January 2013 and May of 2019. Of these, 222 transported by Emergency Medical Services (EMS) had complete run sheets in the electronic medical record from 44 different outside hospitals. Primary data points included the reason for transfer (limitations of the referring hospital, patient or family request, patient requiring a higher level of care, physician request, prior care done at the center), total transfer time, patient insurance type (private, government funded, workers compensation, military, self-pay, other), and disposition (ED procedure, operating room surgery, outpatient follow-up without procedure).
RESULTS: Of the 222 complete patient records, 62 were related to hand pathology, of which 6 were pediatric. There was no significant difference between the number of traumatic versus non-traumatic pathologies when comparing the hand group versus the other orthopaedic transfers (p = 0.349). The longest portion of the total transfer occurred from between when the transfer was accepted and when the sending facility contacted EMS (1:27:13, ranging from 0:01:35 to 23:45:55 (hh:mm:ss)). The reasons for transfer, however, were different with limitations of the transporting hospital and the patient requiring a higher level of care being most common reasons for transfer of hand pathologies (p=0.015). The total transfer time did not vary between pathologies of the hand and others (p=0.106), but within the hand cases, those with traumatic injuries were transferred significantly faster than those with non-traumatic complaints (4:00:38 vs 2:31:13, p=0.40). Among the hand cases the total transfer time was longer for injuries that were ultimately treated either in the outpatient setting or ED than for injuries that were eventually treated surgically (p=0.039). The insurance type of those with hand complaints did not impact transport time or final disposition (p=0.9, p=0.064).
CONCLUSIONS: Transport times of non-traumatic, non-surgically treated hand cases are significantly longer than those traumatic hand injuries which end up going to surgery. Neither transport time nor final disposition were impacted by patient insurance type.
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